Provider Demographics
NPI:1982665402
Name:GAUTHIER, POLLY KING (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:KING
Last Name:GAUTHIER
Suffix:
Gender:F
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:PO BOX 421849
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-1849
Mailing Address - Country:US
Mailing Address - Phone:713-741-6677
Mailing Address - Fax:713-748-5860
Practice Address - Street 1:2525 W. BELLFORT AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5024
Practice Address - Country:US
Practice Address - Phone:713-741-6677
Practice Address - Fax:713-748-5860
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6452207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97527Medicare UPIN
8A4193Medicare ID - Type Unspecified
8820J4Medicare ID - Type Unspecified