Healthcare Provider Details

I. General information

NPI: 1518981489
Provider Name (Legal Business Name): DAVID A POMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N. PARK DRIVE
SELAH WA
98942
US

IV. Provider business mailing address

PO BOX 2947
YAKIMA WA
98907-2947
US

V. Phone/Fax

Practice location:
  • Phone: 509-697-5511
  • Fax: 509-697-9313
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-249-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00042073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: