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Organization
KENNETH W PONDER MD PA
Active
Organization
KENNETH W PONDER MD PA
Active
Other names
Bluewater Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WAYNE PONDER M.D. (PRESIDENT)
(850) 517-7877
Entity
Organization
Contact information
Practice address
4566 E HIGHWAY 20 STE 103, NICEVILLE, FL 32578-8839
(850) 897-1223
(850) 897-1237
Mailing address
4704 KNOLLWOOD RD, NICEVILLE, FL 32578-8760
(850) 517-7877
(832) 336-3826
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0063310
FL
Other
Enumeration date
09/27/2006
Last updated
12/29/2021
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