Provider Demographics
NPI:1780850693
Name:CARLOS R PONCE MD PA
Entity Type:Organization
Organization Name:CARLOS R PONCE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-542-1531
Mailing Address - Street 1:5700 N EXPRESSWAY
Mailing Address - Street 2:STE 303
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4353
Mailing Address - Country:US
Mailing Address - Phone:956-542-1531
Mailing Address - Fax:956-542-0028
Practice Address - Street 1:5700 N EXPRESSWAY
Practice Address - Street 2:STE 303
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4353
Practice Address - Country:US
Practice Address - Phone:956-542-1531
Practice Address - Fax:956-542-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5886207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195627801Medicaid
00Z366Medicare PIN