Provider Demographics
NPI:1124022918
Name:PONTIUS, JILL K (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17844 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-9447
Mailing Address - Country:US
Mailing Address - Phone:903-589-9000
Mailing Address - Fax:903-586-9200
Practice Address - Street 1:5656 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9641
Practice Address - Country:US
Practice Address - Phone:903-589-9000
Practice Address - Fax:903-586-9200
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH51972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88X632Medicare PIN
TXF01367Medicare UPIN