Provider Demographics
NPI:1770570111
Name:POLINGER, IRIS SANDRA (MD PHD)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:SANDRA
Last Name:POLINGER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:MRS
Other - First Name:IRIS
Other - Middle Name:SANDRA
Other - Last Name:POLINGER-HYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:4915 S MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4601
Mailing Address - Country:US
Mailing Address - Phone:281-491-9278
Mailing Address - Fax:281-491-3376
Practice Address - Street 1:4915 S MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4601
Practice Address - Country:US
Practice Address - Phone:281-491-9278
Practice Address - Fax:281-491-3376
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE811T207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B25570Medicare UPIN
BCBSJC47Medicare ID - Type Unspecified