Individual
JAIME PONCE-PORTUGAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7405 SHALLOWFORD ROAD, SUITE 160, CHATTANOOGA, TN 37421
(706) 278-6403
(706) 278-0087
Mailing address
1949 GUNBARREL ROAD,, SUITE 230, CHATTANOOGA, TN 37421
(423) 495-4620
(423) 495-4934
Taxonomy
Speciality
Code
Description
License number
State
207RB0002X
Obesity Medicine (Internal Medicine) Physician
36423
TN
208600000X
Surgery Physician
046635
GA
208600000X
Surgery Physician
Primary
36423
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00815361A
—
GA
Enumeration date
05/11/2006
Last updated
12/19/2024
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