Provider Demographics
NPI:1780672634
Name:PONCY, PAUL DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:PONCY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-2222
Mailing Address - Country:US
Mailing Address - Phone:641-856-5578
Mailing Address - Fax:641-856-6022
Practice Address - Street 1:236 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-2222
Practice Address - Country:US
Practice Address - Phone:641-856-5578
Practice Address - Fax:641-856-6022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA00835Medicare UPIN