Kenneth W Ponder MD PA
Internal Medicine in Niceville, FL. Organization (NPI-2).
NPI number1962593574
StatusActive
Last updated in NPPESDec 29, 2021
Details
- NPI
- 1962593574
- Entity type
- Organization (NPI-2)
- Legal business name
- Kenneth W Ponder MD PA
- Organization subpart
- No
- Enumeration date
- Sep 27, 2006
- Certification date
- Dec 29, 2021
- Last updated
- Dec 29, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | ME0063310 | FL | Yes |
Other names
- Bluewater Medicine (Doing Business As)
Practice location
4566 E Highway 20 Ste 103Niceville, FL 32578-8839
Phone 850-897-1223 · Fax 850-897-1237
Mailing address
4704 Knollwood RdNiceville, FL 32578-8760
Phone 850-517-7877 · Fax 832-336-3826
Authorized official
Kenneth Wayne Ponder
President
8505177877
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