Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 26393 | KY |
Y | 207Q00000X | Family Doctor | MD2015-0638 | NM |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 26393 | KY |
NPI | 1003943416 |
---|---|
Provider Name | Mr. John A Bond |
First Address | Albuquerque, NM 87114-5915 |
Second Address | Albuquerque, NM 87114-5915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 27/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64263932 | (05) | KY |
D69012 | (02) |