Provider Demographics
NPI:1609158229
Name:IRIS S. POLINGER, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:IRIS S. POLINGER, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:POLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-491-9278
Mailing Address - Street 1:1415 HIGHWAY 6
Mailing Address - Street 2:BUILDING C-400
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4908
Mailing Address - Country:US
Mailing Address - Phone:281-491-9278
Mailing Address - Fax:281-491-3376
Practice Address - Street 1:1415 HIGHWAY 6
Practice Address - Street 2:BUILDING C-400
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4908
Practice Address - Country:US
Practice Address - Phone:281-491-9278
Practice Address - Fax:281-491-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8117207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSJC47Medicare PIN