Provider Demographics
NPI:1659792091
Name:WILLIAM W BONDURANT III, M.D., P.A.
Entity Type:Organization
Organization Name:WILLIAM W BONDURANT III, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:409-739-3238
Mailing Address - Street 1:7 COLONY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1737
Mailing Address - Country:US
Mailing Address - Phone:409-739-3238
Mailing Address - Fax:
Practice Address - Street 1:6801 EMMETT F LOWRY EXPY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2500
Practice Address - Country:US
Practice Address - Phone:409-739-3238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134185424OtherPERSONAL NPI NUMBER