Provider Demographics
NPI:1407155070
Name:BONIN, REAGAN DARICE NOVAK (MD)
Entity Type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:DARICE NOVAK
Last Name:BONIN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:CHARLES WILSON OUTPATIENT VA CLINIC
Mailing Address - Street 2:2206 N JOHN REDDITT DR.
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:369-671-4300
Mailing Address - Fax:936-671-4323
Practice Address - Street 1:CHARLES WILSON OUTPATIENT CLINIC
Practice Address - Street 2:2206 N JOHN REDDITT DR
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-671-4300
Practice Address - Fax:936-671-4323
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.207258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine