Provider Demographics
NPI:1336248723
Name:PON, DAVID MING (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MING
Last Name:PON
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:601 E DIXIE AVE
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5953
Mailing Address - Country:US
Mailing Address - Phone:352-787-4588
Mailing Address - Fax:352-323-9022
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:SUITE 1003
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-787-4588
Practice Address - Fax:352-323-9022
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLME58295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051690200Medicaid
FL051690200Medicaid
FLE12921Medicare UPIN