Organization
LU PONCE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LU PONCE MD (OWNER)
(615) 325-2821
Entity
Organization
Contact information
Practice address
102 W KNIGHT ST, PORTLAND, TN 37148-1415
(615) 325-2821
(615) 325-9742
Mailing address
102 W KNIGHT ST, PORTLAND, TN 37148-1415
(615) 325-2821
(615) 325-9742
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
7332
TN
Other
Enumeration date
03/06/2008
Last updated
03/06/2008
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