Individual
ROGER KARL PONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 S 13TH ST STE 3, HERRIN, IL 62948-3666
(618) 988-6157
Mailing address
2 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(305) 331-1675
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
036167569
IL
208600000X
Surgery Physician
ME102585
FL
208C00000X
Colon & Rectal Surgery Physician
ME102585
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000504600
—
FL
01
—
001722622
BLUE CROSS BLUE SHIELD
—
01
—
V006270
CHAMPUS
—
Enumeration date
05/27/2006
Last updated
01/23/2024
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