Healthcare Provider Details

I. General information

NPI: 1104921741
Provider Name (Legal Business Name): ROLAND PONARSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 MARK DR
MONROE LA
71201-5152
US

IV. Provider business mailing address

1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71105-6000
US

V. Phone/Fax

Practice location:
  • Phone: 318-460-5127
  • Fax: 318-460-1967
Mailing address:
  • Phone: 318-798-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09892R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: