Provider Demographics
NPI:1417126434
Name:RUBEN POLLAK, DPM, PC
Entity Type:Organization
Organization Name:RUBEN POLLAK, DPM, PC
Other - Org Name:RUBEN POLLAK, DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-769-7960
Mailing Address - Street 1:1369 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-2037
Mailing Address - Country:US
Mailing Address - Phone:503-769-7960
Mailing Address - Fax:503-769-9860
Practice Address - Street 1:1369 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-2037
Practice Address - Country:US
Practice Address - Phone:503-769-7960
Practice Address - Fax:503-769-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-24
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00368213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271049Medicaid
ORU77638Medicare UPIN
OR271049Medicaid
OR134188Medicare PIN