Provider Demographics
NPI:1528192085
Name:PONCE, ARTURO M (LSA)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:M
Last Name:PONCE
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290690
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79929-0690
Mailing Address - Country:US
Mailing Address - Phone:505-532-7000
Mailing Address - Fax:
Practice Address - Street 1:1755 CURIE DR
Practice Address - Street 2:STE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2919
Practice Address - Country:US
Practice Address - Phone:505-532-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084JROtherBCBS OF TX