Provider Demographics
NPI:1346464195
Name:POLANCO, EUFEMIO CONTRERAS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:EUFEMIO
Middle Name:CONTRERAS
Last Name:POLANCO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:1209 N MILLER RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1043
Practice Address - Country:US
Practice Address - Phone:623-386-5785
Practice Address - Fax:623-386-6673
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0783428OtherTAX-ID