Provider Demographics
NPI:1457462046
Name:POMIDOR, ALICE KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:KAREN
Last Name:POMIDOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1115 W CALL ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4300
Mailing Address - Country:US
Mailing Address - Phone:850-644-1543
Mailing Address - Fax:850-645-0577
Practice Address - Street 1:1264 METROPOLITAN BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2536
Practice Address - Country:US
Practice Address - Phone:850-523-7410
Practice Address - Fax:850-523-7363
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME91581207QG0300X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E18451Medicare UPIN
FLU6197UMedicare Oscar/Certification