Provider Demographics
NPI:1588669626
Name:POLLACK, EVAN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JAY
Last Name:POLLACK
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 1:5749 S GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3728
Mailing Address - Country:US
Mailing Address - Phone:720-489-4177
Mailing Address - Fax:
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-689-0088
Practice Address - Fax:303-343-8011
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39611208D00000X
CAG56102208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13354Medicare UPIN