Provider Demographics
NPI:1427007327
Name:BONNETT, CARL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHN
Last Name:BONNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WURZBACH RD
Mailing Address - Street 2:STE 1110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4330
Mailing Address - Country:US
Mailing Address - Phone:210-556-1430
Mailing Address - Fax:
Practice Address - Street 1:8600 WURZBACH RD
Practice Address - Street 2:STE 1110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-556-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41233208D00000X, 207P00000X
TXP8449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51786338Medicaid
COI22346Medicare UPIN
CO51786338Medicaid