Provider Demographics
NPI:1144223744
Name:MACFARLANE, BONNY A (MD)
Entity type:Individual
Prefix:
First Name:BONNY
Middle Name:A
Last Name:MACFARLANE
Suffix:
Gender:F
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:PO BOX 2533
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-2533
Mailing Address - Country:US
Mailing Address - Phone:806-212-6640
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:4510 S BELL STREET
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-212-4835
Practice Address - Fax:806-212-0900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84X839Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH ENTERP
G39303Medicare UPIN