Provider Demographics
NPI:1871597443
Name:SUAREZ, BONADELVERT C (MD)
Entity type:Individual
Prefix:DR
First Name:BONADELVERT
Middle Name:C
Last Name:SUAREZ
Suffix:
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 1:42421 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2405
Mailing Address - Country:US
Mailing Address - Phone:985-542-1317
Mailing Address - Fax:985-542-1958
Practice Address - Street 1:42421 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2405
Practice Address - Country:US
Practice Address - Phone:985-542-1317
Practice Address - Fax:985-542-1958
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04720R208800000X
LAMD04720R2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1313033Medicaid
LAB89230Medicare UPIN
LA5M241Medicare ID - Type Unspecified