Healthcare Provider Details

I. General information

NPI: 1881760007
Provider Name (Legal Business Name): FRANK DANIAL POLANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/06/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 SPRING MOUNTAIN RD S C
LAS VEGAS NV
89146
US

IV. Provider business mailing address

6630 SPRING MOUNTAIN RD S C
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-899-6990
  • Fax: 702-751-3499
Mailing address:
  • Phone: 702-899-6990
  • Fax: 702-751-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21842
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number26542
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number21842
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: