Healthcare Provider Details

I. General information

NPI: 1780850693
Provider Name (Legal Business Name): CARLOS R PONCE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N EXPRESSWAY STE 303
BROWNSVILLE TX
78526-4353
US

IV. Provider business mailing address

5700 N EXPRESSWAY STE 303
BROWNSVILLE TX
78526-4353
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 NumberM5886
License Number StateTX

VIII. Authorized Official

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