Individual
DR. JOHN A. PONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2201 N CENTRAL EXPY STE 185, RICHARDSON, TX 75080-2763
(303) 933-8270
Mailing address
2331 CAMINO DEL VERDES PL, ROUND ROCK, TX 78681-2257
(512) 341-8382
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
15572
NV
2085R0202X
Diagnostic Radiology Physician
Primary
K6245
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0423154-02
—
TX
01
—
0423154-03
CSHCN
TX
01
—
300127137
RR/MEDICARE
TX
01
—
8F2751
BLUE SHIELD
TX
Enumeration date
03/31/2006
Last updated
04/30/2015
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