Individual
HENRY PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
BOX 159 NAVSUBASE NLON, NAVAL UNDERSEA MEDICAL INSTITUTE, GROTON, CT 06349-5159
(860) 694-6491
Mailing address
15 SEAGULL RD, GROTON, CT 06340-2617
(817) 721-3568
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/04/2015
Last updated
05/04/2015
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