Healthcare Provider Details

I. General information

NPI: 1194752592
Provider Name (Legal Business Name): THOMAS K BOND SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 S COLLEGE RD SUITE 106
LAFAYETTE LA
70503-3060
US

IV. Provider business mailing address

913 S COLLEGE RD SUITE 106
LAFAYETTE LA
70503-3060
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-7209
  • Fax: 337-264-7214
Mailing address:
  • Phone: 337-264-7209
  • Fax: 337-264-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number15178R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: