Provider Demographics
NPI:1225034168
Name:POMONIS, NICK S (DO)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:S
Last Name:POMONIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54655
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4655
Mailing Address - Country:US
Mailing Address - Phone:409-882-0995
Mailing Address - Fax:409-883-4440
Practice Address - Street 1:3306 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4236
Practice Address - Country:US
Practice Address - Phone:409-882-0995
Practice Address - Fax:409-883-4440
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126948201Medicaid
TX760252466Medicaid
TX1225034168Medicaid
TX00A18HMedicare ID - Type UnspecifiedMEDICARE
TX1225034168Medicaid