Provider Demographics
NPI:1083850242
Name:POLAGE, DAVID LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:POLAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SPEYERS ROAD
Mailing Address - Street 2:B39-15 YAKIMA VALLEY SCHOOL
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1099
Mailing Address - Country:US
Mailing Address - Phone:509-698-1300
Mailing Address - Fax:509-697-2230
Practice Address - Street 1:609 SPEYERS RD
Practice Address - Street 2:B39-15 YAKIMA VALLEY SCHOOL
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1099
Practice Address - Country:US
Practice Address - Phone:509-698-1300
Practice Address - Fax:509-697-2230
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00012820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics