Provider Demographics
NPI:1982753620
Name:GARRY R POLLOCK, M.D., P.A.
Entity Type:Organization
Organization Name:GARRY R POLLOCK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-771-3030
Mailing Address - Street 1:4642 N LOOP 289 STE 105
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2422
Mailing Address - Country:US
Mailing Address - Phone:806-771-3030
Mailing Address - Fax:
Practice Address - Street 1:4642 N LOOP 289 STE 105
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2422
Practice Address - Country:US
Practice Address - Phone:806-771-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0204207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H1561OtherBLUE CROSS BLUE SHIELD
TX122132704Medicaid
TX400000574OtherMEDICARE RAILROAD
TX121644100OtherFIRSTCARE
TX400000574OtherMEDICARE RAILROAD