Provider Demographics
NPI:1306158720
Name:CONTRACT PHYSICIAN
Entity type:Organization
Organization Name:CONTRACT PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:SEARING
Authorized Official - Last Name:POND
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-621-7442
Mailing Address - Street 1:412 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:UM
Mailing Address - Phone:251-621-7442
Mailing Address - Fax:251-621-7442
Practice Address - Street 1:412 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4001
Practice Address - Country:US
Practice Address - Phone:251-621-7442
Practice Address - Fax:251-621-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6782261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone