Healthcare Provider Details

I. General information

NPI: 1417126434
Provider Name (Legal Business Name): RUBEN POLLAK, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2008
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1369 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7960
  • Fax: 503-769-9860
Mailing address:
  • Phone: 503-769-7960
  • Fax: 503-769-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00368
License Number StateOR

VIII. Authorized Official

Name: DR. RUBEN POLLAK
Title or Position: PRESIDENT/OWNER/PRACTITIONER
Credential: D.P.M.
Phone: 503-769-7960