Individual
DR. CHARLES P. BONDURANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1605 E BROADWAY, SUITE 100, COLUMBIA, MO 65201-8023
(573) 815-4242
(573) 815-4245
Mailing address
1605 E BROADWAY, SUITE 100, COLUMBIA, MO 65201-8023
(573) 815-4242
(573) 815-4245
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
R8J14
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206949802
—
MO
Enumeration date
08/19/2005
Last updated
07/22/2020
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