Provider Demographics
NPI:1497862684
Name:BONNER, ROBERT ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:BONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3975 JACKSON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-353-0333
Mailing Address - Fax:951-353-0366
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-353-0333
Practice Address - Fax:951-353-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60851207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53619Medicare UPIN