Provider Demographics
NPI:1891955951
Name:JOSEPH W BONURA DPM PA
Entity Type:Organization
Organization Name:JOSEPH W BONURA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BONURA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-318-2088
Mailing Address - Street 1:226A SAINT JOE PLAZA DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3615
Mailing Address - Country:US
Mailing Address - Phone:904-318-2088
Mailing Address - Fax:904-940-8669
Practice Address - Street 1:226A SAINT JOE PLAZA DR
Practice Address - Street 2:SUITE 127
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-3615
Practice Address - Country:US
Practice Address - Phone:904-318-2088
Practice Address - Fax:904-940-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty