Healthcare Provider Details

I. General information

NPI: 1821393935
Provider Name (Legal Business Name): FRED WILLIS POMEROY DVM, ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 7TH ST E
SAINT PAUL MN
55101-2302
US

IV. Provider business mailing address

185 7TH ST E
SAINT PAUL MN
55101-2302
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-4815
  • Fax:
Mailing address:
  • Phone: 651-224-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number01674
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: