MEDICARE: JILL K PONTIUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	H5197	TX

General Provider Information

NPI Number	:	1124022918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL K PONTIUS MD

Provider Business Mailing Address
First Line	:	17844 SUNSET STRIP
Second Line	:
City	:	FLINT
State	:	TX
Zip	:	75762-9447
Country	:	US
Telephone Number	:	903-589-9000
Fax Number	:	903-586-9200

Provider Business Practice Location Address
First Line	:	5656 N JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9641
Country	:	US
Telephone Number	:	903-589-9000
Fax Number	:	903-586-9200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/31/2008

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