Provider Demographics
NPI:1497940506
Name:BOND, BREA ANN (MD)
Entity Type:Individual
Prefix:
First Name:BREA
Middle Name:ANN
Last Name:BOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PHS PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 26666
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:5550 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3167
Practice Address - Country:US
Practice Address - Phone:505-462-6600
Practice Address - Fax:505-462-6669
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97675207Q00000X
NMMD2016-0484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84508019Medicaid