Individual
DR. JEFFREY S PONKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1149 VISTA PARK DR STE C, FOREST, VA 24551-4685
(434) 616-2455
Mailing address
18 PAISLEY WAY, ORANGEVILLE, ON L9W 6-Z5
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101277770
VA
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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