Bonfardin, Brian R

Bonfardin, Brian R is an sole proprietor health care provider with primary practice located at 2306 Knob Creek Rd Ste 104 , Johnson City TN 37604-2366. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Bonfardin, Brian R can be contacted via phone (423) 794-7490.

Contact Information

Primary practice address
2306 Knob Creek Rd Ste 104 Johnson City TN 37604-2366
Phone: (423) 794-7490
Fax: (423) 735-0289
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 22059 Tennessee

Profile Details

NPI number 1356322515
LBN Legal business name Bonfardin, Brian R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 7th, 2005
Last updated Aug 12th, 2026 - about 3 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356322515 NPPES
Tennessee MEDICAID BB2996140
Tennessee Other 22059

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