MEDICARE: DR. JAMES PETER BONAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	L 0036	TX
2	208600000X	Surgery Physician	L0036	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871572123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PETER BONAR M.D.

Provider Business Mailing Address
First Line	:	5099 CEDAR CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-2401
Country	:	US
Telephone Number	:	713-471-8113
Fax Number	:	713-295-6169

Provider Business Practice Location Address
First Line	:	500 MEDICAL CENTER BLVD
Second Line	:	STE 100
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	936-788-8084
Fax Number	:	936-788-8054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2006
Last Update Date	:	07/21/2022

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