Provider Demographics
NPI:1417033739
Name:BONNER, EVERETT J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:J
Last Name:BONNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4373
Mailing Address - Country:US
Mailing Address - Phone:225-246-9790
Mailing Address - Fax:225-246-9100
Practice Address - Street 1:7373 PERKINS RD.
Practice Address - Street 2:BATON ROUGE CLINIC - ATTN: DEE - ADMINISTRATION
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4326
Practice Address - Country:US
Practice Address - Phone:225-769-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054561208600000X
LA2018692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1076392Medicaid
LA4N103Medicare PIN