Provider Demographics
NPI:1376794883
Name:PONCE, PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:PONCE
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 1:17000 PORTER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:407-635-3013
Mailing Address - Fax:407-636-7844
Practice Address - Street 1:17000 PORTER RD STE 208
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:407-635-3013
Practice Address - Fax:407-636-7844
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12942390200000X
FLME10845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program