Provider Demographics
NPI:1467762484
Name:ROBERT BONDURANT MD PA
Entity Type:Organization
Organization Name:ROBERT BONDURANT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-479-4000
Mailing Address - Street 1:10095 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5428
Mailing Address - Country:US
Mailing Address - Phone:850-479-4000
Mailing Address - Fax:850-475-9009
Practice Address - Street 1:10095 HILLVIEW RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5428
Practice Address - Country:US
Practice Address - Phone:850-479-4000
Practice Address - Fax:850-475-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13174207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17270Medicare PIN
D53207Medicare UPIN