Provider Demographics
NPI:1174960736
Name:PONDER, DWIGHT LYNN II
Entity type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:LYNN
Last Name:PONDER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 SALSBURY LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2046
Mailing Address - Country:US
Mailing Address - Phone:405-501-5736
Mailing Address - Fax:
Practice Address - Street 1:8817 SALSBURY LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-2046
Practice Address - Country:US
Practice Address - Phone:405-501-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management