Provider Demographics
NPI:1669447371
Name:BONDURANT, WILLIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BONDURANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-471-6611
Practice Address - Fax:405-471-5858
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK19073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG30040Medicare UPIN