Individual
SEAN ANTHONY PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3802 S 700 E, SALT LAKE CITY, UT 84106-1182
(801) 264-6004
(801) 264-6098
Mailing address
3802 S 700 E, SALT LAKE CITY, UT 84106-1182
(801) 264-6004
(801) 264-6098
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
4976571-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376577049
—
UT
Enumeration date
07/10/2006
Last updated
04/29/2016
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