Provider Demographics
NPI:1063606317
Name:BENEFIELD, BONNIE MORTON (DO)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MORTON
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 JOG RD
Mailing Address - Street 2:SUITE 107-108
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2164
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:
Practice Address - Street 1:15300 JOG RD
Practice Address - Street 2:SUITE 107-108
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2164
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D97217Medicare UPIN