Provider Demographics
NPI:1588662225
Name:BONAU, ROGER A (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:BONAU
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 1:53 CENTURY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3693
Mailing Address - Country:US
Mailing Address - Phone:615-292-5722
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:4535 HARDING PIKE STE 304
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2120
Practice Address - Country:US
Practice Address - Phone:615-269-9007
Practice Address - Fax:615-269-3448
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19695208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3044987Medicare PIN
TND93644Medicare UPIN
TN30449841Medicare PIN