Provider Demographics
NPI:1982743787
Name:PONDER, COREY E (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:E
Last Name:PONDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1110 N LEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2612
Mailing Address - Country:US
Mailing Address - Phone:405-218-2530
Mailing Address - Fax:405-218-2535
Practice Address - Street 1:13401 N. WESTERN AVE.
Practice Address - Street 2:STE. 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-478-7111
Practice Address - Fax:405-478-7112
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-06-16
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Provider Licenses
StateLicense IDTaxonomies
OK22884207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1578658035OtherOKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE