Provider Demographics
NPI:1790921344
Name:PONTIOUS, DAVID ERIC (MPAS, PAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ERIC
Last Name:PONTIOUS
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Gender:
Credentials:MPAS, PAC
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Other - First Name:
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Mailing Address - Street 1:6087 S REDWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6854
Mailing Address - Country:US
Mailing Address - Phone:855-473-8489
Mailing Address - Fax:855-749-6881
Practice Address - Street 1:6087 S REDWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-6854
Practice Address - Country:US
Practice Address - Phone:855-473-8489
Practice Address - Fax:855-749-6881
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2025-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3604841206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant