Provider Demographics
NPI:1285639781
Name:POLAND, PAMELA J (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:POLAND
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Gender:F
Credentials:MD
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Mailing Address - Street 1:400 FAIRVIEW AVE
Mailing Address - Street 2:STE 18
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1920
Mailing Address - Country:US
Mailing Address - Phone:580-762-5696
Mailing Address - Fax:580-762-7622
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:STE 18
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1920
Practice Address - Country:US
Practice Address - Phone:580-762-5696
Practice Address - Fax:580-762-7622
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-03-13
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Provider Licenses
StateLicense IDTaxonomies
OK17919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF04842Medicare UPIN
OK0591080001Medicare NSC