Basic Information
| Provider Information | |||||||||
| NPI: | 1144292715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POMELOW | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4438 CENTERVIEW | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782281440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102800040 | ||||||||
| FaxNumber: | 2102800060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4438 CENTERVIEW | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782281440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102800040 | ||||||||
| FaxNumber: | 2102800060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA05109 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 318808801 | 01 | TX | WELLMED MEDICAID | OTHER | TXB157017 | 01 | TX | WELLMED MEDICARE | OTHER |