Provider Demographics
NPI:1063685386
Name:LLOYD, BONNIE WATSON (DO)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:WATSON
Last Name:LLOYD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:KATHLEEN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:7655 38TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1263
Practice Address - Country:US
Practice Address - Phone:727-345-1332
Practice Address - Fax:727-345-3200
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01606000Medicaid
FLCV147ZMedicare PIN