Provider Demographics
NPI:1194931592
Name:JAMES R BOND, JR MD PA
Entity type:Organization
Organization Name:JAMES R BOND, JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:817-488-5555
Mailing Address - Street 1:1615 LANCASTER DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2111
Mailing Address - Country:US
Mailing Address - Phone:817-488-5555
Mailing Address - Fax:817-421-0400
Practice Address - Street 1:1615 LANCASTER DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2111
Practice Address - Country:US
Practice Address - Phone:817-488-5555
Practice Address - Fax:817-421-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH1928Medicare UPIN
TX00L60QMedicare PIN