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General NPI Number Information
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NPI Number | 1770877037
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Entity Type | Individual
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Provider Name | PHILIP JOHN BRONDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 110 DENNIS DR
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City | SANFORD
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State | NC
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Zip | 27330-6343
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Country | US
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Telephone | 919-774-4511
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Fax | 919-774-3196
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Provider Business Mailing Address
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Address Line | 205 PAGE RD
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City | PINEHURST
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State | NC
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Zip | 28374-8798
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Country | US
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Telephone | 910-295-5511
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2015-00344
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 248178
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License Number State | MA
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