Provider Demographics
NPI:1902807365
Name:BONDAR, GEORGE LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LESLIE
Last Name:BONDAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4200 N ARMENIA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6438
Mailing Address - Country:US
Mailing Address - Phone:813-877-4811
Mailing Address - Fax:813-872-8978
Practice Address - Street 1:9170 OAKHURST RD STE 1
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2112
Practice Address - Country:US
Practice Address - Phone:727-517-3376
Practice Address - Fax:727-517-3370
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6144207ND0101X, 207N00000X
WAOP00001470207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33185Medicare UPIN