Provider Demographics
NPI:1164482147
Name:BOND, DMYTRO (MD)
Entity Type:Individual
Prefix:DR
First Name:DMYTRO
Middle Name:
Last Name:BOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DMYTRO
Other - Middle Name:
Other - Last Name:BONDARYEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5751 S FORT APACHE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-939-0480
Mailing Address - Fax:702-939-0482
Practice Address - Street 1:5751 S FORT APACHE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5624
Practice Address - Country:US
Practice Address - Phone:702-939-0480
Practice Address - Fax:702-939-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003102645Medicaid
NV002018545Medicaid