Provider Demographics
NPI:1801902515
Name:BOND, CARLOS WILLIAM (D O)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:WILLIAM
Last Name:BOND
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SAINT JOHNS WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2435
Mailing Address - Country:US
Mailing Address - Phone:208-798-7388
Mailing Address - Fax:208-798-8151
Practice Address - Street 1:307 SAINT JOHNS WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-798-7388
Practice Address - Fax:208-798-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-57207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1102094Medicaid
ID1300642Medicare ID - Type Unspecified
WA1102094Medicaid