MEDICARE: MATTHEW BONIN PA

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	363A00000X	Physician Assistant	PA9102671	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174540001	OTHER	FL	CIGNA GOUT SVCS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992752554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BONIN PA

Provider Business Mailing Address
First Line	:	10475 CENTURION PKWY N STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5004
Country	:	US
Telephone Number	:	904-223-3321
Fax Number	:	904-223-2169

Provider Business Practice Location Address
First Line	:	10475 CENTURION PKWY N STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5004
Country	:	US
Telephone Number	:	904-223-3321
Fax Number	:	904-223-2169

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	05/09/2019

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Directions to “ MATTHEW BONIN PA” Practice Location

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