Basic Information
| Provider Information | |||||||||
| NPI: | 1902807365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONDAR | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | LESLIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 N ARMENIA AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138774811 | ||||||||
| FaxNumber: | 8138728978 | ||||||||
| Practice Location | |||||||||
| Address1: | 9170 OAKHURST RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337762112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275173376 | ||||||||
| FaxNumber: | 7275173370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | OS6144 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207ND0101X | OP00001470 | WA | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207N00000X | OS6144 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.