Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD019556E | PA |
NPI | 1053319574 |
---|---|
Provider Name | Dr. Jeffrey L Pollock |
First Address | Churchville, PA 18966-1325 |
Second Address | Huntingdon Valley, PA 19006-5309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 11/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C28418 | (02) | PA |