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General NPI Number Information
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NPI Number | 1902867740
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Entity Type | Individual
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Provider Name | JOHN A. PONZO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 2201 N CENTRAL EXPY STE 185
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City | RICHARDSON
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State | TX
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Zip | 75080-2763
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Country | US
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Telephone | 303-933-8270
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 CAMINO DEL VERDES PL
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City | ROUND ROCK
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State | TX
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Zip | 78681-2257
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Country | US
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Telephone | 512-341-8382
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | K6245
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15572
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License Number State | NV
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