Healthcare Provider Details

I. General information

NPI: 1194703447
Provider Name (Legal Business Name): JAMES DAVID POLK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHNSON SPACE CENTER- NASA FLIGHT MEDICINE CLINIC 2101 NASA ROAD 1
HOUSTON TX
77058
US

IV. Provider business mailing address

711 RED OAK LN
FRIENDSWOOD TX
77546-3591
US

V. Phone/Fax

Practice location:
  • Phone: 281-483-6063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL2558
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberL2558
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: