Provider Demographics
NPI:1932283330
Name:BONNICK, SYDNEY LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:LOU
Last Name:BONNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2921 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8624
Mailing Address - Country:US
Mailing Address - Phone:940-484-5010
Mailing Address - Fax:940-484-5020
Practice Address - Street 1:2921 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8624
Practice Address - Country:US
Practice Address - Phone:940-484-5010
Practice Address - Fax:940-484-5020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE0825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAK30OtherBLUECROSS/BLUESHIELD
TXAK30OtherBLUECROSS/BLUESHIELD