Provider Demographics
NPI:1871630483
Name:POLGLASE, ROBERT F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:POLGLASE
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 1:3969 INVERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-650-7798
Mailing Address - Fax:
Practice Address - Street 1:521 HILL ST, S.W.
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824
Practice Address - Country:US
Practice Address - Phone:706-597-5253
Practice Address - Fax:706-597-5159
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037338207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61271Medicare UPIN
GA93BFCLPMedicare PIN