Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 01054119A | IN |
N | 207U00000X | Nuclear Medicine Specialist | 14212 | PR |
N | 207U00000X | Nuclear Medicine Specialist | 19973 | AL |
NPI | 1194831719 |
---|---|
Provider Name | Dr. Carmen Olga Ponton |
First Address | Birmingham, AL 35223-2505 |
Second Address | Birmingham, AL 35233-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |