Basic Information
Provider Information
NPI: 1225039746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOND
FirstName: JOHN
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 21850
Address2:  
City: HOT SPRINGS
State: AR
PostalCode: 719031850
CountryCode: US
TelephoneNumber: 5016232781
FaxNumber: 5016231774
Practice Location
Address1: 1662 HIGDON FERRY RD
Address2: SUITE 200
City: HOT SPRINGS
State: AR
PostalCode: 719136999
CountryCode: US
TelephoneNumber: 5016232781
FaxNumber: 5016231774
Other Information
ProviderEnumerationDate: 08/09/2005
LastUpdateDate: 02/28/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XC4456ARY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
10236800105AR MEDICAID


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