Provider Demographics
NPI:1396885034
Name:POMEROY, J TALISMAU
Entity type:Individual
Prefix:
First Name:J
Middle Name:TALISMAU
Last Name:POMEROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:T
Other - Last Name:POMEROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3035 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073
Mailing Address - Country:US
Mailing Address - Phone:831-462-8755
Mailing Address - Fax:831-475-5713
Practice Address - Street 1:3035 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-462-8750
Practice Address - Fax:831-475-5713
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG414340207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A18570Medicare UPIN
ZZZ02844ZMedicare ID - Type Unspecified