Provider Demographics
NPI:1881760007
Name:POLANCO, FRANK DANIAL (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:DANIAL
Last Name:POLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6630 SPRING MOUNTAIN RD
Mailing Address - Street 2:S C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-899-6990
Mailing Address - Fax:702-751-3499
Practice Address - Street 1:6630 SPRING MOUNTAIN RD
Practice Address - Street 2:S C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-899-6990
Practice Address - Fax:702-751-3499
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV21842207LP2900X, 2083P0500X
CO26542207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250021508Medicaid