Provider Demographics
NPI:1376591826
Name:POLLOCK, JUDSON B (MD)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:B
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-967-5584
Mailing Address - Fax:651-293-8106
Practice Address - Street 1:205 WABASHA ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1805
Practice Address - Country:US
Practice Address - Phone:952-967-5584
Practice Address - Fax:651-293-8106
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-02-05
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Provider Licenses
StateLicense IDTaxonomies
MN56213207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2440791Medicaid
OH2440791Medicaid
OHM99458Medicare UPIN