| Doctor Name: | DR. MACK STUART BONNER |
| NPI Number: | 1407857501 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 27125 |
| Business Practice Address: | 590 S Trade St Tryon, NC - 287823714 |
| Business Phone Number: | 8288590420 |
| Business Fax Number: | 8288590422 |
| Mailing Address: | 590 S Trade St, TRYON |
| State: | NC |
| Postal Code: | 287823714 |
| Phone Number: | 8288590420 |
| Fax Number: | 8288590422 |
| NPI Enumeration Date: | 08/10/2005 |
| NPI Last Update Date: | 03/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 27125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |