Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 01031616A | IN |
NPI | 1376543926 |
---|---|
Provider Name | Dr. Patrick A Pontee |
First Address | Hammond, IN 46320-1965 |
Second Address | Hammond, IN 46320-1965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100168970 | (05) | IN |
B29110 | (02) |