Healthcare Provider Details

I. General information

NPI: 1336177583
Provider Name (Legal Business Name): TERRELL MORGAN BOND JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S CALHOUN ST
FORT WAYNE IN
46802-5257
US

IV. Provider business mailing address

1717 S CALHOUN ST
FORT WAYNE IN
46802-5257
US

V. Phone/Fax

Practice location:
  • Phone: 260-458-2641
  • Fax: 260-458-2574
Mailing address:
  • Phone: 260-458-2641
  • Fax: 260-458-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: