Provider Demographics
NPI:1700810801
Name:BONET, ANGEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:BONET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STATE ROAD 19 STE 48
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2449
Mailing Address - Country:US
Mailing Address - Phone:787-895-9999
Mailing Address - Fax:
Practice Address - Street 1:400 N STATE ROAD 19 STE 48
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2449
Practice Address - Country:US
Practice Address - Phone:386-329-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14979208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH99107Medicare UPIN
PR22152Medicare ID - Type Unspecified