Provider Demographics
NPI:1053623264
Name:BONAME, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BONAME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4657 OLD LOONEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2640
Mailing Address - Country:US
Mailing Address - Phone:205-967-8390
Mailing Address - Fax:
Practice Address - Street 1:4657 OLD LOONEY MILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2640
Practice Address - Country:US
Practice Address - Phone:205-967-8390
Practice Address - Fax:205-969-3723
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL3160173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine