Individual
JAMES MICHAEL PONTIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
302 N INDEPENDENCE STREET, SUITE 700, ENID, OK 73701-4046
(580) 249-3795
(580) 234-3299
Mailing address
367 S GULPH RD, ATN :IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(580) 249-3795
(580) 234-3299
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12733
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100130040 A
—
OK
05
—
100130040C
—
OK
Enumeration date
06/01/2006
Last updated
08/24/2021
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