Provider Demographics
NPI:1619959335
Name:BONNER, ALEXANDER C (DPM)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:BONNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 CAMPO SANO AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1174
Mailing Address - Country:US
Mailing Address - Phone:305-669-3339
Mailing Address - Fax:305-233-5220
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:305-669-3339
Practice Address - Fax:305-233-5220
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO626213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL406480210OtherRAILROAD MEDICARE
FL650028975OtherAETNA
FL029603100Medicaid
FL650025975OtherTAX ID
FL16002OtherSFCN/PSN
FL029603100OtherSFCN
FL650028975OtherCIGNA
FL650028975OtherHEALTHOPTIONS
FL87359OtherBLUE CROSS BLUE SHIELD
FL212695OtherAVMED
FL650028975OtherUNITED HEALTHCARE
FL16002OtherSFCN/PSN
FL650028975OtherUNITED HEALTHCARE
FL5131200001Medicare NSC