Provider Demographics
NPI:1598775025
Name:JEROME V PONDER MD PC
Entity Type:Organization
Organization Name:JEROME V PONDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:V
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-480-4880
Mailing Address - Street 1:413 OWEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3489
Mailing Address - Country:US
Mailing Address - Phone:910-480-4880
Mailing Address - Fax:910-488-4856
Practice Address - Street 1:413 OWEN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3489
Practice Address - Country:US
Practice Address - Phone:910-480-4880
Practice Address - Fax:910-488-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty