Provider Demographics
NPI:1275545105
Name:BONNER, JOCELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:
Last Name:BONNER
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:P.O. BOX 5795
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-915-0178
Mailing Address - Fax:541-334-6285
Practice Address - Street 1:1140 WILLAGILLESPIE ROAD
Practice Address - Street 2:SUITE 44
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-735-3241
Practice Address - Fax:541-735-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR191982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry