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General NPI Number Information
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NPI Number | 1336393941
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Entity Type | Individual
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Provider Name | TRAVIS BOND MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 3000 KENNEDY DR APT 5
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2127
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Country | US
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Telephone | 801-205-4106
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 KENNEDY DRIVE #5
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City | SALT LAKE CITY
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State | UT
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Zip | 84108
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Country | US
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Telephone | 801-205-4106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 7151938-1205
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License Number State | UT
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