Provider Demographics
NPI:1588618904
Name:POMPA, PAUL HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:POMPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S HULEN ST
Mailing Address - Street 2:SUITE 124-207
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1929
Mailing Address - Country:US
Mailing Address - Phone:817-350-6114
Mailing Address - Fax:
Practice Address - Street 1:3000 S HULEN ST
Practice Address - Street 2:SUITE 124-207
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1929
Practice Address - Country:US
Practice Address - Phone:817-350-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0906207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142803908Medicaid
TX142803905Medicaid
TX0014KLOtherBCBS
TX00953PMedicare PIN
TX0014KLOtherBCBS
TX142803908Medicaid
TXP00052873Medicare PIN