Provider Demographics
NPI:1760701528
Name:POMEROY, DAVID PHIPPS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHIPPS
Last Name:POMEROY
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 1:2000 116TH AVE NE STE 6
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3047
Mailing Address - Country:US
Mailing Address - Phone:425-454-8684
Mailing Address - Fax:206-339-5465
Practice Address - Street 1:2000 116TH AVE NE STE 6
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3047
Practice Address - Country:US
Practice Address - Phone:425-454-8684
Practice Address - Fax:206-339-5465
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015957207Q00000X
WA15957208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1608702Medicaid