Provider Demographics
NPI:1255331781
Name:BONILLA, JOSE ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARTURO
Last Name:BONILLA
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 29749
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0749
Mailing Address - Country:US
Mailing Address - Phone:210-733-4386
Mailing Address - Fax:210-402-3417
Practice Address - Street 1:16723 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2342
Practice Address - Country:US
Practice Address - Phone:210-733-4368
Practice Address - Fax:210-402-3417
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7913207YP0228X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B0097102OtherDPS
TXH7913OtherSTATE LIC
TX100216403Medicaid
BB2654906OtherDEA