Provider Demographics
NPI:1144292715
Name:POMELOW, CHRISTOPHER DAVID (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:POMELOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4438 CENTERVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1440
Mailing Address - Country:US
Mailing Address - Phone:210-280-0040
Mailing Address - Fax:210-280-0060
Practice Address - Street 1:4438 CENTERVIEW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1440
Practice Address - Country:US
Practice Address - Phone:210-280-0040
Practice Address - Fax:210-280-0060
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157017OtherWELLMED MEDICARE
TX318808801OtherWELLMED MEDICAID