Healthcare Provider Details

I. General information

NPI: 1639380546
Provider Name (Legal Business Name): IAN DOUGLAS BOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W BASELINE RD STE 101
MESA AZ
85202-9098
US

IV. Provider business mailing address

1855 W BASELINE RD STE 101
MESA AZ
85202-9098
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-7566
  • Fax:
Mailing address:
  • Phone: 480-831-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR78457
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number65816
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: