Organization Name: | SUSAN B. PONCY, MD PA |
NPI Number: | 1518183185 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KAREN BARLOW (OWNER BILLING COMPANY) |
Mailing Address: | 601 University Blvd Suite 201 Jupiter |
State: | FL US |
Postal Code: | 33458 |
Phone Number: | 5616272727 |
Fax Number: | 5616274327 |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME80003 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |