Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 44011 | CO |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 44011 | CO |
NPI | 1356470876 |
---|---|
Provider Name | Dr. Jamie M. Pollock |
First Address | Pueblo, CO 81004-2008 |
Second Address | Pueblo, CO 81004-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25833375 | (05) | CO |