Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | J0204 | TX |
NPI | 1164577672 |
---|---|
Provider Name | Garry Robert Pollock |
First Address | Lubbock, TX 79416-2423 |
Second Address | Lubbock, TX 79416-2423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 14/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8H1561 | BLUE CROSS BLUE SHIELD (01) | TX |
F64224 | (02) | TX |