Provider Demographics
NPI:1295804987
Name:PONDER, REAGAN (MD)
Entity type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:
Last Name:PONDER
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 1:7192 KALANIANAOLE HWY
Mailing Address - Street 2:SUITE A200
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1800
Mailing Address - Country:US
Mailing Address - Phone:808-396-6321
Mailing Address - Fax:808-395-7160
Practice Address - Street 1:7192 KALANIANAOLE HWY
Practice Address - Street 2:SUITE A200
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1800
Practice Address - Country:US
Practice Address - Phone:808-396-6321
Practice Address - Fax:808-395-7160
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0245435OtherHMSA
HI569543 03Medicaid
HII31428Medicare UPIN
HI00C0245435OtherHMSA