DR. MARCUS C PONCE DE LEON (NPI# 1659417434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659417434 |
| Entity Type | Individual |
| Full Name | DR. MARCUS C PONCE DE LEON |
| Credential | M.D. |
| Practice Address |
Madigan Army Medical Ctr 9040 Jackson Avenue Tacoma WA 98431-1100 |
| Mailing Address |
Madigan Army Medical Ctr 90390 Gardner Loop Rd Tacoma WA 98431-0001 |
| Practice Telephone | 2539686478 |
| Practice Fax Number | 2539689054 |
| Mailing Telephone | 2539686478 |
| Mailing Fax Number | 2539689054 |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-10-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD61012423 | WA | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
050245 | GA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6401 Kimball Dr Fl 2, Gig Harbor, WA 983351228 | 2539852722 | 2539852853 |
| Street Address |
MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVENUE |
| City | TACOMA |
| State | WA |
| Zip Code | 98431-1100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689657801 | Jeffrey Scott Kunz | Internal Medicine | Madigan Army Medical Ctr 9040 Jackson Avenue, Tacoma, WA 98431-0001 | 2005-11-22 |
| 1992018907 | Karen T. Lesniak | Psychologist | Madigan Army Medical Ctr 9040 Jackson Avenue, Tacoma, WA 98431-1100 | 2010-07-19 |
| 1659432102 | William Charles Keppler IIi | Psychiatry & Neurology | Madigan Army Medical Ctr 9040 Jackson Avenue, Tacoma, WA 98431-0001 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275954646 | George Delyanis | Psychiatry & Neurology | 1220 Ventura Dr, Tacoma, WA 98465-1240 | 2014-01-02 |
| 1346403383 | Stacy L. Donlon | Psychiatry & Neurology | 915 6th Ave Ste 100, Tacoma, WA 98405-4682 | 2008-07-09 |
| 1316114184 | Edward Tay | Psychiatry & Neurology | 209 Martin Luther King Jr. Way, Group Health Cooperative, Tacoma Specialty Center Neuro, Tacoma, WA 98405 | 2008-05-12 |
| 1023297769 | Cristina Cruz-crespo | Psychiatry & Neurology | Madigan Army Medical Center-neurology, 9040a Fitzsimmons Drive, Tacoma, WA 98431-0001 | 2007-10-30 |
| 1114990587 | Jay C. Erickson | Psychiatry & Neurology | 1608 S J St Fl 5, Tacoma, WA 98405-4930 | 2006-02-08 |
| 1831177922 | Keyi Yang | Psychiatry & Neurology | 1708 So. Yakima Ave, Ste 118, Tacoma, WA 98405-5307 | 2006-01-09 |
| 1275530859 | John Robert Huddlestone | Psychiatry & Neurology | 915 6th Ave, Ste 200, Tacoma, WA 98405-4682 | 2005-06-28 |
| 1205290368 | Keith Andrew Groshans | Psychiatry & Neurology | 9040 Jackson Ave, Tacoma, WA 98431-0004 | 2016-04-05 |
| 1568889731 | Derek Ting Yu | Psychiatry & Neurology | 209 Martin Luther King Jr Way, Tacoma, WA 98405-4265 | 2014-03-25 |
| 1205271442 | James Joseph Gutierrez | Psychiatry & Neurology | 209 Martin Luther King Jr Way, Tacoma, WA 98405 | 2013-05-01 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.