Provider Demographics
NPI:1609213925
Name:PONCE MENDEZ, ARLENNE JEANETTE (MD)
Entity Type:Individual
Prefix:
First Name:ARLENNE
Middle Name:JEANETTE
Last Name:PONCE MENDEZ
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1431
Mailing Address - Country:US
Mailing Address - Phone:850-770-3220
Mailing Address - Fax:850-770-3225
Practice Address - Street 1:2420 JENKS AVE STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4909
Practice Address - Country:US
Practice Address - Phone:850-770-3260
Practice Address - Fax:850-770-3225
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19808390200000X
PR33086-R390200000X
PR32644-R390200000X
FLME136481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1609213925Medicaid