Provider Demographics
NPI:1164577672
Name:POLLOCK, GARRY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:ROBERT
Last Name:POLLOCK
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 1:4642 N LOOP 289, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2423
Mailing Address - Country:US
Mailing Address - Phone:806-771-3030
Mailing Address - Fax:806-771-3034
Practice Address - Street 1:4642 N LOOP 289, SUITE 105
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2423
Practice Address - Country:US
Practice Address - Phone:806-771-3030
Practice Address - Fax:806-771-3034
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0204207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H1561OtherBLUE CROSS BLUE SHIELD
TX8F1036Medicare PIN
TXF64224Medicare UPIN