person
Dr. Samuel Ponce Nandin, MD
General Practice Physician in Goodyear, Arizona
NPI 1124180054

Samuel Ponce Nandin is a General Practice Physician based in Goodyear, AZ. Samuel Ponce Nandin practices in Goodyear, AZ and has the professional credentials of MD. The NPI Number for Samuel Ponce Nandin is 1124180054 and holds a License No. AZ15582 (Arizona).

The current practice location address for Samuel Ponce Nandin is 13851 W La Mar Blvd, Goodyear, AZ and can be reached out via phone at 623-925-2622 and via fax at 623-925-9260.

Location: 13851 W La Mar Blvd, Goodyear, AZ, 85338-1389
person
Provider Profile Details
NPI Number
1124180054
Provider Name
Samuel Ponce Nandin
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
13851 W La Mar Blvd, Goodyear, AZ, 85338-1389
Phone Number
623-925-2622
Fax Number
623-925-9260
Provider Enumeration Date
12/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
106223600 01 AZ OWCP
562491245 01 AZ AZ. FOUNDATION FOR MEDICA
562491245 01 AZ LIFE WISE HEALTHPLAN
562491245 01 AZ UNITEDHEALTH CARE
562491245 01 AZ SCF OF ARIZONA
AZ0766630 01 AZ BCBS OF AZ
562491245 01 AZ HUMANA
273607001 01 AZ AHCCCS
562491245 01 AZ BEECHSTREET NETWORK
2Z1748 01 AZ HEALTH NET
5008111 01 AZ AETNA PROVIDER NO.
institution
Provider Business Practice Location Address Details
Address
13851 W La Mar Blvd
City
State
Zip
85338-1389
Phone Number
623-925-2622
Fax Number
623-925-9260
person
Provider Business Mailing Address Details
Address
13851 W La Mar Blvd
City
State
Zip
85338-1389
Phone Number
623-925-2622
Fax Number
623-925-9260
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
AZ15582 (Arizona)
Definition
Definition to come...
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