Provider Demographics
NPI:1306830898
Name:MCDONALD WATSON, BONNIE L (DO)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:MCDONALD WATSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18555 N 79TH AVE
Mailing Address - Street 2:B 108
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8370
Mailing Address - Country:US
Mailing Address - Phone:623-773-2848
Mailing Address - Fax:623-773-0370
Practice Address - Street 1:18555 N 79TH AVE
Practice Address - Street 2:STE B108
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8372
Practice Address - Country:US
Practice Address - Phone:623-773-2848
Practice Address - Fax:623-773-0370
Is Sole Proprietor?:No
Enumeration Date:2005-09-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI34085Medicare UPIN
AZZ10396Medicare PIN