Healthcare Provider Details

I. General information

NPI: 1679641997
Provider Name (Legal Business Name): JOHN B BONDHUS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 HIGDON FERRY RD SUITE 100
HOT SPRINGS AR
71913-6999
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-520-5476
  • Fax: 501-520-5486
Mailing address:
  • Phone: 501-520-5476
  • Fax: 501-520-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA202
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: