Provider Demographics
NPI:1457445025
Name:POLY, STEPHEN G (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:G
Last Name:POLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211-2216
Mailing Address - Country:US
Mailing Address - Phone:575-748-3333
Mailing Address - Fax:575-748-8540
Practice Address - Street 1:702 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1199
Practice Address - Country:US
Practice Address - Phone:575-748-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical