Provider Demographics
NPI:1871871806
Name:BRONDON, BRIDGET (DPM)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BRONDON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W ELMWOOD DR STE 311
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4278
Mailing Address - Country:US
Mailing Address - Phone:937-433-0444
Mailing Address - Fax:937-433-0405
Practice Address - Street 1:77 W ELMWOOD DR STE 311
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4278
Practice Address - Country:US
Practice Address - Phone:937-433-0444
Practice Address - Fax:937-433-0405
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068320Medicaid
OH0068320Medicaid
OHP01337512Medicare PIN