Provider Demographics
NPI:1497788178
Name:BONNER, DONALD R (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:BONNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7539
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39284-7539
Mailing Address - Country:US
Mailing Address - Phone:601-376-1848
Mailing Address - Fax:601-376-1894
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-1848
Practice Address - Fax:601-376-1894
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13234207L00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0114973Medicaid
MS0114973Medicaid
MS050000606Medicare ID - Type Unspecified