Individual
GINA PONTIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1811 S MAIN ST, PALMYRA, MO 63461-1961
(573) 769-2231
(573) 769-3953
Mailing address
1811 S MAIN ST, PALMYRA, MO 63461-1961
(573) 769-2231
(573) 769-3953
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-052624
IL
207Q00000X
Family Medicine Physician
Primary
2010020899
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871793257
—
MO
Enumeration date
07/23/2007
Last updated
04/18/2024
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