Active NPI
Robert Ellis Bonham, M.D.
- Otolaryngology Physician
- Dallas, TX
National Provider Identifier
1649264359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- D3155
- Practice address
- 4104 Junius St.
Dallas, TX 75246 - Phone
- (214) 742-2194
- Fax
- (214) 827-0162
- NPI assigned
- Sep 8, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | D3155 | TX | Primary |
Addresses
Primary practice location
4104 Junius St.
Dallas, TX 75246
Mailing address
4104 Junius St.
Dallas, TX 75246
Phone (214) 742-2194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3155 | TX | MD | Otology & Neurotology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225670400000",
"number": "1649264359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4104 JUNIUS ST.",
"city": "DALLAS",
"state": "TX",
"postal_code": "75246",
"telephone_number": "214-742-2194",
"fax_number": "214-827-0162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4104 JUNIUS ST.",
"city": "DALLAS",
"state": "TX",
"postal_code": "75246",
"telephone_number": "214-742-2194",
"fax_number": "214-827-0162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONHAM",
"first_name": "ROBERT",
"middle_name": "ELLIS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-08",
"last_updated": "2008-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TX",
"license": "D3155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.