Provider Demographics
NPI:1205814019
Name:PONS, PETER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:PONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W COLLEGE ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5323
Mailing Address - Country:US
Mailing Address - Phone:256-764-2482
Mailing Address - Fax:256-764-2982
Practice Address - Street 1:541 W COLLEGE ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5323
Practice Address - Country:US
Practice Address - Phone:256-764-2482
Practice Address - Fax:256-764-2982
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL269652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004432OtherBCBS
E12444Medicare UPIN
NYS52744Medicare ID - Type Unspecified