Provider Demographics
NPI:1710943279
Name:POLLENS, JEFFREY MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:POLLENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15403 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8491
Mailing Address - Country:US
Mailing Address - Phone:402-496-0003
Mailing Address - Fax:402-496-0003
Practice Address - Street 1:15403 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8491
Practice Address - Country:US
Practice Address - Phone:402-496-0003
Practice Address - Fax:402-496-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE211213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NET92986Medicare UPIN
NE275722Medicare ID - Type UnspecifiedMEDICARE NUMBER