Provider Demographics
NPI:1982627014
Name:BONNER, STEVEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:BONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-446-2360
Mailing Address - Fax:704-366-3746
Practice Address - Street 1:309 SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2886
Practice Address - Country:US
Practice Address - Phone:704-446-2360
Practice Address - Fax:704-366-3746
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16790OtherBSBC
NC1982627014Medicaid
NC8916790Medicaid
NC16790OtherBSBC
NC203207DMedicare PIN