Individual provider Active NPI

Harris L Bonnette, M.D.

  • Neurology Physician
  • Fort Myers, FL
National Provider Identifier
1114928009
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01085010A Issued in IN
Practice address
13782 Plantation Rd Ste 201
Fort Myers, FL 33912-4462
Phone
(239) 343-1290
Fax
(239) 343-4008
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X ME0029202 FL
Neurology Physician 2084N0400X 01085010A IN Primary

Addresses

Primary practice location

13782 Plantation Rd Ste 201
Fort Myers, FL 33912-4462

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 424-1449

Other practice location 1

11104 Parkview Circle Dr Ste 110
Fort Wayne, IN 46845-1673
Phone (260) 425-6780

Other identifiers 1

IdentifierTypeStateIssuer
037453900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0029202FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Radiology Consultants P a Past Accepting new patients
Major Hospital Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1114928009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-424-1449",
            "fax_number": "239-424-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13782 PLANTATION RD STE 201",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124462",
            "telephone_number": "239-343-1290",
            "fax_number": "239-343-4008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11104 Parkview Circle Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451673",
            "country_code": "US",
            "telephone_number": "260-425-6780",
            "fax_number": "260-425-6789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONNETTE",
        "first_name": "HARRIS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME0029202",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01085010A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037453900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.