Provider Demographics
NPI:1083609481
Name:BONNAIRE, HARRY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:JOSEPH
Last Name:BONNAIRE
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 1:601 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3536
Mailing Address - Country:US
Mailing Address - Phone:931-393-5112
Mailing Address - Fax:931-393-2247
Practice Address - Street 1:607 W DUE WEST AVE STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4420
Practice Address - Country:US
Practice Address - Phone:615-868-2229
Practice Address - Fax:615-868-2432
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1083609481OtherNPI
TN3000061OtherTULLAHOMA MEDICARE
TN3000061Medicaid
TN3807797Medicaid
TN3807797OtherMEDICARE OTHER
TN3000061Medicaid
TNE51012Medicare UPIN
TN3000061Medicaid