Provider Demographics
NPI:1396807657
Name:STEVEN H. BONNER M.D.,P,C,
Entity type:Organization
Organization Name:STEVEN H. BONNER M.D.,P,C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-758-8274
Mailing Address - Street 1:505 ENERGY CENTER BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5826
Mailing Address - Country:US
Mailing Address - Phone:205-758-8274
Mailing Address - Fax:205-758-8374
Practice Address - Street 1:505 ENERGY CENTER BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5826
Practice Address - Country:US
Practice Address - Phone:205-758-8274
Practice Address - Fax:205-758-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK671Medicare ID - Type Unspecified
ALG93097Medicare UPIN