Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301081774 | MI |
N | 111NI0900X | Internist | 4301081774 | MI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301081774 | MI |
NPI | 1043338650 |
---|---|
Provider Name | Dr. Nathan Pomeroy |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 18/02/2021 |