Basic Information
| Provider Information | |||||||||
| NPI: | 1831150408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONTEMPS | ||||||||
| FirstName: | ERNST | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 EXECUTIVE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337625323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273490005 | ||||||||
| FaxNumber: | 7275416558 | ||||||||
| Practice Location | |||||||||
| Address1: | 7017 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273842016 | ||||||||
| FaxNumber: | 7273433791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME83742 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 09008 | 01 | FL | BCBS | OTHER | 100016262 | 01 | RAILROAD MEDICARE | OTHER | 264350200 | 05 | FL | MEDICAID | N217005 | 01 | FL | WELLCARE | OTHER |