Provider Demographics
NPI:1407002322
Name:BONNER, BRYON EMIL
Entity Type:Individual
Prefix:
First Name:BRYON
Middle Name:EMIL
Last Name:BONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S. BELLEVUE BLVD.
Mailing Address - Street 2:APT. 1601
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-496-8990
Mailing Address - Fax:
Practice Address - Street 1:305 S. BELLEVUE BLVD.
Practice Address - Street 2:APT. 1601
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-496-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)