Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 121538 | FL |
NPI | 1023213071 |
---|---|
Provider Name | Estuardo Alfonso Ponce |
First Address | Tarpon Springs, FL 34689-6221 |
Second Address | Tarpon Springs, FL 34689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 16/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME 121538 | NPI 1023213071 (01) | FL |