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Individual
PONCET COURTLAND BILLS
Active
Individual
PONCET COURTLAND BILLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34004017
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000120136
ANTHEM
OH
01
—
000000699797
ANTHEM
OH
01
—
010063626
RRMCR
OH
05
—
0971480
—
OH
Enumeration date
06/13/2005
Last updated
11/11/2011
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