Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 241002 | MA |
N | 208000000X | Pediatrician | 47543 | AZ |
Y | 2080P0204X | Pediatric Emergency Doctor | 251391 | MA |
NPI | 1154556496 |
---|---|
Provider Name | Dr. Jose David Ponce Rios |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2009 |
Last Update Date | 07/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
874417 | (05) | AZ |