Provider Demographics
NPI:1710943196
Name:BONAR, JEANNE R (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:R
Last Name:BONAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:#523
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-569-1049
Mailing Address - Fax:907-563-4564
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:#523
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-569-1049
Practice Address - Fax:907-563-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1682207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY168190Medicaid
AKMD1682Medicaid
C97006Medicare UPIN
CAXPY168190Medicaid