Basic Information
| Provider Information | |||||||||
| NPI: | 1902880420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARD | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7135 MIMOSA LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752305441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143788381 | ||||||||
| FaxNumber: | 2148535415 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 HUNTERS ROW CT | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760634001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174537444 | ||||||||
| FaxNumber: | 8174537441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | K7993 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.