Basic Information
| Provider Information | |||||||||
| NPI: | 1295804987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONDER | ||||||||
| FirstName: | REAGAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7192 KALANIANAOLE HWY | ||||||||
| Address2: | SUITE A200 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968251800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083966321 | ||||||||
| FaxNumber: | 8083957160 | ||||||||
| Practice Location | |||||||||
| Address1: | 7192 KALANIANAOLE HWY | ||||||||
| Address2: | SUITE A200 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968251800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083966321 | ||||||||
| FaxNumber: | 8083957160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD-12290 | HI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00C0245435 | 01 | HI | HMSA | OTHER | 569543 03 | 05 | HI | MEDICAID |