Mark D Bonnen MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

L7985 Issued in TX

Legal business name

MARK D BONNEN MD PA

Practice address

100 Medical Dr # B
Lake Jackson, TX 77566-5674

Phone

(979) 297-9268

Fax

(979) 297-9331

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark D Bonnen, MD

Title

President

Phone

(979) 297-9268

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Ray Garlitos, MD

  • Radiation Oncology Physician
  • Lake Jackson, TX
  • NPI 1386629574
  Medicare reassignment
• Angel I Blanco, M.D.

  • Radiation Oncology Physician
  • Corpus Christi, TX
  • NPI 1447240593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1003928326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N BELLE DR",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775153397",
            "telephone_number": "979-848-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DR # B",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665674",
            "telephone_number": "979-297-9268",
            "fax_number": "979-297-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D BONNEN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BONNEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-297-9268",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "L7985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daisy Lumabas Macasieb, D.D.S.
• Managed Vision Care Inc 042793
• Cynthia Ann Manders, D.D.S.
• Dorothy Manning
• Heidi M Mansy, NP
• Samantha Nicole Marley-McCann, CCC-SLP
• Blaine Marshall
• Jana K Marshall, MD
• Henry Enoc Martinez, M.D.
• Richard Martinez, DC

• Specialist in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.