Healthcare Provider Details

I. General information

NPI: 1588720783
Provider Name (Legal Business Name): DAVID JON POMBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CHANNING WAY STE 306
IDAHO FALLS ID
83404-7546
US

IV. Provider business mailing address

34 PARK ST
HYANNIS MA
02601-5204
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-4567
  • Fax:
Mailing address:
  • Phone: 508-862-5650
  • Fax: 508-778-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberM-16906
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number184097-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number249742
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: