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NPI Code Detail

MEDICARE: SEAN ANTHONY PONCE M.D.

MEDICARE: SEAN ANTHONY PONCE M.D.
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
1207QA0401XAddiction Medicine (Family Medicine) Physician4976571-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376577049
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN ANTHONY PONCE M.D.
Provider Business Mailing Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6004
Fax Number : 801-264-6098
Provider Business Practice Location Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6004
Fax Number : 801-264-6098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 04/29/2016

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Directions to “ SEAN ANTHONY PONCE M.D.” Practice Location

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