Provider Demographics
NPI:1689692493
Name:PONDER, KATHERINE P (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:P
Last Name:PONDER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8125
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8808
Mailing Address - Fax:314-362-8826
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-8808
Practice Address - Fax:314-362-8826
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-29
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Provider Licenses
StateLicense IDTaxonomies
MOR3N04207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO283010183Medicaid
MO283010183Medicaid
MO283010183Medicare PIN
MO283010183Medicaid