Provider Demographics
NPI:1164457677
Name:PONCY, SUSAN BROWN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BROWN
Last Name:PONCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S OLD DIXIE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7200
Mailing Address - Country:US
Mailing Address - Phone:561-745-7094
Mailing Address - Fax:561-741-5584
Practice Address - Street 1:1004 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7200
Practice Address - Country:US
Practice Address - Phone:561-745-7094
Practice Address - Fax:561-741-5584
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80003207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269268600Medicaid
FL51886OtherBCBS
FL51886OtherBCBS
FLK4966Medicare ID - Type Unspecified
FL269268600Medicaid