Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD42220 | TN |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD42220 | TN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD42220 | TN |
NPI | 1255488128 |
---|---|
Provider Name | Dr. Gregory Gerald Polkowski II |
First Address | Nashville, TN 37232-5100 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048813 | CT LICENSE (01) | CT |
1255488128 | (05) | CT |