Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD00012596 | WA |
NPI | 1033147756 |
---|---|
Provider Name | John L. Bondi |
First Address | Renton, WA 98055-4934 |
Second Address | Renton, WA 98055-5738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093400 | (05) | WA |
A04112 | (02) | WA |