MEDICARE: DR. PAUL HENRY POMPA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	L0906	TX
2	207Q00000X	Family Medicine Physician	L0906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0014KL	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1588618904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL HENRY POMPA M.D.

Provider Business Mailing Address
First Line	:	3000 S HULEN ST
Second Line	:	SUITE 124-207
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1929
Country	:	US
Telephone Number	:	817-350-6114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S HULEN ST
Second Line	:	SUITE 124-207
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1929
Country	:	US
Telephone Number	:	817-350-6114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/30/2012

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