Provider Demographics
NPI:1952961161
Name:BONSNESS, JOSEPH RUSSELL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RUSSELL
Last Name:BONSNESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 WALLA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3557
Mailing Address - Country:US
Mailing Address - Phone:623-687-7413
Mailing Address - Fax:
Practice Address - Street 1:910 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3355
Practice Address - Country:US
Practice Address - Phone:817-358-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant