Healthcare Provider Details

I. General information

NPI: 1548209653
Provider Name (Legal Business Name): DAVID BONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE
VANCOUVER WA
98664-1913
US

IV. Provider business mailing address

700 NE 87TH AVE
VANCOUVER WA
98664-1913
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-1500
  • Fax: 360-397-3128
Mailing address:
  • Phone: 360-397-1500
  • Fax: 360-397-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00015272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: