Provider Demographics
NPI:1790866283
Name:BONNEAU, RAYMOND M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:BONNEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:165 ROWLAND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5055
Mailing Address - Country:US
Mailing Address - Phone:415-898-4211
Mailing Address - Fax:415-898-9252
Practice Address - Street 1:165 ROWLAND WAY STE 100
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5055
Practice Address - Country:US
Practice Address - Phone:415-898-4211
Practice Address - Fax:415-898-9252
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30247207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4286600001Medicare NSC
CA00G302470Medicare ID - Type UnspecifiedMEDICARE ID#