Provider Demographics
NPI:1558540591
Name:BONN, GARY E (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:BONN
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 1:12 WINSLOW COURT
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ON
Mailing Address - Zip Code:K2B8H1
Mailing Address - Country:CA
Mailing Address - Phone:613-729-8600
Mailing Address - Fax:
Practice Address - Street 1:105-1335 CARLING AVENUE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:ON
Practice Address - Zip Code:K1Y4P6
Practice Address - Country:CA
Practice Address - Phone:613-729-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39723207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology