Provider Demographics
NPI:1003812264
Name:BONNEN, JAMES GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:BONNEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N TEXAS AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4966
Mailing Address - Country:US
Mailing Address - Phone:281-922-5099
Mailing Address - Fax:281-922-5490
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-922-5099
Practice Address - Fax:281-922-5490
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8359M0Medicare PIN
TX8358M0Medicare PIN
TXG71097Medicare UPIN