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Individual

DR. JIMMY NOLAN PONDER JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218
Mailing address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
020658
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1903680
LA
Enumeration date
01/23/2006
Last updated
07/08/2010
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