Provider Demographics
NPI:1225118193
Name:POLLACK, JO M (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:M
Last Name:POLLACK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:18300 KATY FWY STE 275
Mailing Address - Street 2:MEDICAL OFFICE BUILDING 2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1521
Mailing Address - Country:US
Mailing Address - Phone:713-461-1013
Mailing Address - Fax:713-461-1593
Practice Address - Street 1:18300 KATY FWY STE 275
Practice Address - Street 2:MEDICAL OFFICE BUILDING 2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1521
Practice Address - Country:US
Practice Address - Phone:713-461-1013
Practice Address - Fax:713-461-1593
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-10-20
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Provider Licenses
StateLicense IDTaxonomies
TXJ6665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP038971002Medicaid
TX00678WMedicare ID - Type Unspecified
G71958Medicare UPIN