Provider Demographics
NPI:1992209290
Name:BONNER, RYAN WILLIAM
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:BONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 BURNETT-WOMACK CB# 7155
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7155
Mailing Address - Country:US
Mailing Address - Phone:919-966-2561
Mailing Address - Fax:
Practice Address - Street 1:7024 BURNETT-WOMACK CB#7155
Practice Address - Street 2:DIVISION OF NEPHROLOGY & HYPERTENSION
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7156
Practice Address - Country:US
Practice Address - Phone:919-966-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00692207R00000X, 207RN0300X
NC309243390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology