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General NPI Number Information
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NPI Number | 1548217383
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Entity Type | Individual
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Provider Name | ROGER KARL PONS MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 315 S 13TH ST STE 3
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City | HERRIN
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State | IL
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Zip | 62948-3666
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Country | US
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Telephone | 618-988-6157
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Fax |
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Provider Business Mailing Address
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Address Line | 2 S HOSPITAL DR
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City | MURPHYSBORO
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State | IL
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Zip | 62966-3333
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Country | US
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Telephone | 305-331-1675
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME102585
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | ME102585
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 036167569
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License Number State | IL
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