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General NPI Number Information
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NPI Number | 1740234335
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Entity Type | Individual
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Provider Name | JAMES R POLIQUIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 911 BYPASS RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-1689
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Country | US
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Telephone | 606-218-4530
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Fax | 606-218-4540
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Provider Business Mailing Address
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Address Line | PO BOX 2917
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City | PIKEVILLE
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State | KY
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Zip | 41502-2917
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Country | US
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Telephone | 606-218-4530
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Fax | 606-218-4540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 42475
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101033088
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101033088
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 0101033088
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License Number State | VA
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