Provider Demographics
NPI:1538108816
Name:BONIFACE, JAMES EUGENE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:BONIFACE
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 1:207 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7077
Mailing Address - Country:US
Mailing Address - Phone:716-366-7150
Mailing Address - Fax:716-366-1976
Practice Address - Street 1:207 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:716-366-7150
Practice Address - Fax:716-366-1976
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447324207X00000X
OHOH35062152207X00000X
NY327897-01207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929142Medicaid
OH0170960001Medicare NSC
OHH150291Medicare PIN
OH0929142Medicaid