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General NPI Number Information
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NPI Number | 1104921741
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Entity Type | Individual
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Provider Name | ROLAND PONARSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2806 MARK DR
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City | MONROE
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State | LA
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Zip | 71201-5152
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Country | US
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Telephone | 318-460-5127
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Fax | 318-460-1967
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Provider Business Mailing Address
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Address Line | 1455 E BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105-6000
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Country | US
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Telephone | 318-798-4500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 09892R
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License Number State | LA
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