Provider Demographics
NPI:1396909339
Name:BONSON, JAMES E JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:BONSON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3501
Mailing Address - Country:US
Mailing Address - Phone:210-450-9100
Mailing Address - Fax:210-450-6009
Practice Address - Street 1:8300 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9100
Practice Address - Fax:210-450-6009
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282759401Medicaid
TXTXB129534Medicare PIN