Provider Demographics
NPI:1700849627
Name:BONNER, WALTER MORSE JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MORSE
Last Name:BONNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:890 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6129
Mailing Address - Country:US
Mailing Address - Phone:843-881-9971
Mailing Address - Fax:843-881-9973
Practice Address - Street 1:890 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6129
Practice Address - Country:US
Practice Address - Phone:843-881-9971
Practice Address - Fax:843-881-9973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC3839207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3839OtherSTATE MEDICAL LICENSE
SC038391Medicaid
SC038391Medicaid