Provider Demographics
NPI:1104802669
Name:BOND, STEPHEN COREY
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:COREY
Last Name:BOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 LEMAY AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02542-1558
Mailing Address - Country:US
Mailing Address - Phone:334-803-3552
Mailing Address - Fax:
Practice Address - Street 1:5201 LEE RD.
Practice Address - Street 2:USCG KAEHLER MEMORIAL MEDICAL CLINIC
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02542
Practice Address - Country:US
Practice Address - Phone:508-968-6572
Practice Address - Fax:508-968-6581
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAB1673133146N00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered171000000XOther Service ProvidersMilitary Health Care Provider