Individual
DR. MICHELLE M PONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4500 S GARNETT RD STE 300, TULSA, OK 74146-5238
(918) 935-3550
Mailing address
3013 LAMOND HILL AVE, EDMOND, OK 73034-6980
(405) 361-9042
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22883
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200130260A
—
OK
Enumeration date
02/06/2007
Last updated
12/10/2019
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