Provider Demographics
NPI:1518265784
Name:JEFFREY M. POLLOCK, MD PA
Entity Type:Organization
Organization Name:JEFFREY M. POLLOCK, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-617-0322
Mailing Address - Street 1:201 NW 82 AVENUE
Mailing Address - Street 2:SUITE # 505
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1857
Mailing Address - Country:US
Mailing Address - Phone:954-617-0322
Mailing Address - Fax:954-617-0619
Practice Address - Street 1:201 NW 82 AVENUE
Practice Address - Street 2:SUITE # 505
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1857
Practice Address - Country:US
Practice Address - Phone:954-617-0322
Practice Address - Fax:954-617-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056796207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251590300Medicaid
23502Medicare PIN
FLF67727Medicare UPIN