Provider Demographics
NPI:1902636558
Name:BONDURANT DERMATOLOGY, PLC
Entity type:Organization
Organization Name:BONDURANT DERMATOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-205-4571
Mailing Address - Street 1:88 PAINE CIR STE 4
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1449
Mailing Address - Country:US
Mailing Address - Phone:515-348-6383
Mailing Address - Fax:515-348-6437
Practice Address - Street 1:88 PAINE CIR STE 4
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1449
Practice Address - Country:US
Practice Address - Phone:515-348-6383
Practice Address - Fax:515-348-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty