Provider Demographics
NPI:1134458441
Name:MCTYRE, BONNIE PARKER (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:PARKER
Last Name:MCTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 PREMIER DRIVE
Mailing Address - Street 2:STE 203
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8356
Mailing Address - Country:US
Mailing Address - Phone:336-802-2200
Mailing Address - Fax:336-802-2201
Practice Address - Street 1:4515 PREMIER DRIVE
Practice Address - Street 2:STE 203
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8356
Practice Address - Country:US
Practice Address - Phone:336-802-2200
Practice Address - Fax:336-802-2201
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC192856208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program