Provider Demographics
NPI:1649275025
Name:BONNEY, MARTIN D JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:BONNEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W SMITH VALLEY RD STE C1
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1589
Mailing Address - Country:US
Mailing Address - Phone:317-300-4091
Mailing Address - Fax:
Practice Address - Street 1:1700 W SMITH VALLEY RD STE C1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1589
Practice Address - Country:US
Practice Address - Phone:317-300-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047187A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50004094OtherPASSPORT GROUP # 50000548
KY50004275OtherPASSPORT GROUP # 1172544
KY000000060164OtherBCBS OF KY 12 DIGIT #
KY000000275811OtherBCBS OF KY 12 DIGIT #
KY64040843Medicaid
KY000000060164OtherBCBS OF KY 12 DIGIT #
KY50004094OtherPASSPORT GROUP # 50000548
KY0754609Medicare ID - Type UnspecifiedMEDICARE GROUP # 7546