=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588757462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE S POLLACK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 12/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25510 I 45 NORTH STE200
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-367-1388
-----------------------------------------------------
Fax | 281-681-3885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1059
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77383-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-367-1388
-----------------------------------------------------
Fax | 281-681-3885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | H573
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------