Provider Demographics
NPI:1164583787
Name:BONNET, JEAN SF (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:SF
Last Name:BONNET
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 1:745 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1941
Mailing Address - Country:US
Mailing Address - Phone:617-364-2588
Mailing Address - Fax:
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA73981OtherMA LICENSE
MABB2743513OtherDEA
MAE99158Medicare UPIN