Provider Demographics
NPI:1811097116
Name:POLLAK, SANFORD ZACHARY (DO)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:ZACHARY
Last Name:POLLAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 UNIVERSITY BLVD S
Mailing Address - Street 2:BUILDING 11
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4326
Mailing Address - Country:US
Mailing Address - Phone:904-636-7755
Mailing Address - Fax:904-636-5885
Practice Address - Street 1:4131 UNIVERSITY BLVD S
Practice Address - Street 2:BUILDING 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4326
Practice Address - Country:US
Practice Address - Phone:904-636-7755
Practice Address - Fax:904-636-5885
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5198208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80072YMedicare ID - Type Unspecified
FLX53698Medicare UPIN