Provider Demographics
NPI:1811982721
Name:PONDER, SUSAN D (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:PONDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-599-9600
Mailing Address - Fax:972-599-9696
Practice Address - Street 1:8080 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4000
Practice Address - Country:US
Practice Address - Phone:972-596-9511
Practice Address - Fax:972-599-9696
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-06-03
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Provider Licenses
StateLicense IDTaxonomies
TXM5887207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323750YWGMMedicare PIN
VAG27665Medicare UPIN
VAG27665Medicaid