Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 32181 | AZ |
NPI | 1235193426 |
---|---|
Provider Name | Susan E. Ponkey |
First Address | Chandler, AZ 85246-6730 |
Second Address | Gilbert, AZ 85295-8487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 07/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F87900 | (02) | AZ |