Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2017000597 | MO |
N | 207T00000X | Neurosurgeon | 225485 | NY |
NPI | 1053374835 |
---|---|
Provider Name | Dr. Barry J Pollack |
First Address | Independence, MO 64057-1926 |
Second Address | Independence, MO 64057-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053374835 | (05) | MO |