Provider Demographics
NPI:1871797357
Name:BOND, THERONICA ROOSETTA (MD)
Entity type:Individual
Prefix:
First Name:THERONICA
Middle Name:ROOSETTA
Last Name:BOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 678625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8625
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:817-284-3425
Practice Address - Street 1:3200 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-468-4000
Practice Address - Fax:817-284-3425
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7865208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW000OtherBLUECROSS BLUESHIELD OF TEXAS
BP3-0018732OtherINSTITUTIONAL PERMIT
TX8F22262Medicare PIN
TX8AW000OtherBLUECROSS BLUESHIELD OF TEXAS
TX8K4926Medicare PIN
TX8F22341Medicare PIN
BP3-0018732OtherINSTITUTIONAL PERMIT