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NPI Code Detail

MEDICARE: ERICA PONCE-DOUGHERTY PA-C

MEDICARE: ERICA PONCE-DOUGHERTY PA-C
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
1363AS0400XSurgical Physician Assistant1508649310OK
2363AM0700XMedical Physician Assistant1508649310OK
3363A00000XPhysician Assistant1508649310OK

General Provider Information

NPI Number : 1508649310
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA PONCE-DOUGHERTY PA-C
Provider Business Mailing Address
First Line : 14100 PARKWAY COMMONS DR STE 100
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6036
Country : US
Telephone Number : 405-748-3300
Fax Number : 405-749-1671
Provider Business Practice Location Address
First Line : 14100 PARKWAY COMMONS DR STE 100
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6036
Country : US
Telephone Number : 405-748-3300
Fax Number : 405-749-1671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2023
Last Update Date : 06/01/2026

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Directions to “ ERICA PONCE-DOUGHERTY PA-C” Practice Location

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