Provider Demographics
NPI:1437131463
Name:POLLET, RANDY J (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:J
Last Name:POLLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-7456
Mailing Address - Country:US
Mailing Address - Phone:915-533-3486
Mailing Address - Fax:915-532-0977
Practice Address - Street 1:1725 BROWN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-7456
Practice Address - Country:US
Practice Address - Phone:915-533-3486
Practice Address - Fax:915-532-0977
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1712207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0164280001OtherDMERC
1437131463OtherNATIONAL PROVIDER I D
1437131463OtherNATIONAL PROVIDER I D
TXB25574Medicare UPIN
TX0164280001OtherDMERC