Provider Demographics
NPI:1750346086
Name:POLANCO, JOSE F (MD, PA)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:POLANCO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1014
Mailing Address - Country:US
Mailing Address - Phone:941-708-3358
Mailing Address - Fax:941-749-1046
Practice Address - Street 1:311 3RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1014
Practice Address - Country:US
Practice Address - Phone:941-708-3358
Practice Address - Fax:941-749-1046
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL593599123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110194124OtherRAILROAD MC
FL003131900Medicaid
FL322675OtherAETNA
FL41923OtherBCBS
FLG63071Medicare UPIN
FL003131900Medicaid