Provider Demographics
NPI:1184642407
Name:BONNER, JAMES FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANCIS
Last Name:BONNER
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-0374
Mailing Address - Country:US
Mailing Address - Phone:610-490-3900
Mailing Address - Fax:610-490-3904
Practice Address - Street 1:206 N UNION ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3430
Practice Address - Country:US
Practice Address - Phone:307-777-3711
Practice Address - Fax:302-777-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039149L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009691660001Medicaid
PA0009691660001Medicaid
PA0009691660001Medicaid