Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 15178R | LA |
NPI | 1194752592 |
---|---|
Provider Name | Dr. Thomas K Bond SR. |
First Address | Lafayette, LA 70503-3060 |
Second Address | Lafayette, LA 70503-3060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15178R | MEDICAL LICENSE (01) | LA |
BB8480523 | DEA (01) | LA |
H94424 | (02) | LA |