Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01034723A | IN |
Y | 111NI0900X | Internist | 01034723A | IN |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01034723A | IN |
NPI | 1043286305 |
---|---|
Provider Name | Roy Daniel Pollom |
First Address | Indianapolis, IN 46216-1056 |
Second Address | Indianapolis, IN 46216-1056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000342152 | ANTHEM (01) | IN |
100191590 | (05) | IN |
200881880 | (05) | IN |
A37107 | (02) | IN |