Provider Demographics
NPI:1346386844
Name:PONDER, GAYLE W (MD)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:W
Last Name:PONDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1264 TAMU
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1264
Mailing Address - Country:US
Mailing Address - Phone:979-458-8300
Mailing Address - Fax:979-458-8319
Practice Address - Street 1:1264 TAMU
Practice Address - Street 2:TEXAS A&M UNIVERSITY - STUDENT HEALTH SERVICES
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1264
Practice Address - Country:US
Practice Address - Phone:979-458-8300
Practice Address - Fax:979-458-8319
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUG97680Medicare UPIN