Provider Demographics
NPI:1144244252
Name:BONCHAK, JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BONCHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1201 E 9TH ST
Mailing Address - Street 2:SAM RAYBURN MEMORIAL VETERANS CENTER
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4059
Mailing Address - Country:US
Mailing Address - Phone:903-583-2111
Mailing Address - Fax:903-583-6709
Practice Address - Street 1:SAM RAYBURN MEMORIAL VETERANS CENTER
Practice Address - Street 2:1201 E.9TH ST.
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2228
Practice Address - Country:US
Practice Address - Phone:903-583-2111
Practice Address - Fax:903-583-6709
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine