Provider Demographics
NPI:1386709707
Name:PONCE, CARLOS ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:PONCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 N EXPRESSWAY
Mailing Address - Street 2:#303
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4353
Mailing Address - Country:US
Mailing Address - Phone:956-542-1531
Mailing Address - Fax:956-542-0028
Practice Address - Street 1:5700 N EXPRESSWAY
Practice Address - Street 2:#303
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4310
Practice Address - Country:US
Practice Address - Phone:956-542-1531
Practice Address - Fax:956-542-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5886207RI0008X, 207RG0100X
GA051371207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191309701Medicaid
TX191309702Medicaid
TX191309702Medicaid
TX8F8401Medicare PIN