Provider Demographics
NPI:1184696064
Name:BONU, COMFORT (MD)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:
Last Name:BONU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:PHYSICIAN PRACTICES
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-989-6130
Mailing Address - Fax:505-820-5408
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:ST. VINCENT HOSPITALIST GROUP
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-989-6130
Practice Address - Fax:505-820-5408
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049085A208000000X
NMMD2010-0050207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200200060Medicaid
G82036Medicare UPIN