Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 32375 | MN |
Y | 207YS0123X | Facial Plastic Surgeon | 33079 | SC |
NPI | 1316917057 |
---|---|
Provider Name | Dr. Peter C Bondy |
First Address | Conway, SC 29528-2180 |
Second Address | Conway, SC 29526-8747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330797 | (05) | SC |
AA6304 | (02) | SC |
GP4505 | (05) | SC |