Provider Demographics
NPI:1740234335
Name:POLIQUIN, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:POLIQUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-4530
Mailing Address - Fax:606-218-4540
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-4530
Practice Address - Fax:606-218-4540
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY424752086S0129X
VA0101033088208600000X, 2086S0129X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4357943OtherAETNA PPO/MC
1458520OtherCIGNA
213383OtherOPTIMUM CHOICE
020044164OtherRAILROAD MEDICARE
213383OtherALLIANCE/MDIPA/MAMSI
KY7100175390Medicaid
0582455OtherAETNA HMO
071140OtherANTHEM
VA15802OtherOPTIMA MEDICAID
285008OtherSOUTHERN HEALTH
VA15802OtherOPTIMA MEDICAID
KY7100175390Medicaid