Provider Demographics
NPI:1477547867
Name:BOND, DOUGLAS M (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:BOND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9449
Mailing Address - Street 2:3936 N DAVIS HWY STE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-9449
Mailing Address - Country:US
Mailing Address - Phone:850-433-8414
Mailing Address - Fax:850-436-8435
Practice Address - Street 1:3936 N DAVIS HWY
Practice Address - Street 2:STE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2746
Practice Address - Country:US
Practice Address - Phone:850-433-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
40528OtherBCBS OF FL GROUP ID
FL54799OtherBCBS OF FL
AL590-94645OtherBCBS OF AL
525553OtherAETNA
FL54799OtherBCBS OF FL
G56234Medicare UPIN