Healthcare Provider Details

I. General information

NPI: 1124125869
Provider Name (Legal Business Name): ROBERTO PONCE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N EXPRESSWAY #303
BROWNSVILLE TX
78526-4310
US

IV. Provider business mailing address

5700 N EXPRESSWAY #303
BROWNSVILLE TX
78526-4310
US

V. Phone/Fax

Practice location:
  • Phone: 956-542-1531
  • Fax: 956-542-0028
Mailing address:
  • Phone: 956-542-1531
  • Fax: 956-542-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberF3582
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERTO PONCE
Title or Position: PRESIDENT
Credential: MD
Phone: 956-542-1531