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General NPI Number Information
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NPI Number | 1750346086
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Entity Type | Individual
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Provider Name | JOSE F POLANCO M.D., P.A.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 311 3RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1014
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Country | US
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Telephone | 941-708-3358
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Fax | 941-749-1046
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Provider Business Mailing Address
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Address Line | 311 3RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1014
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Country | US
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Telephone | 941-708-3358
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Fax | 941-749-1046
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 593599123
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License Number State | FL
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Legacy Identifiers
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Identifier #1
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Identifier Code | 110194124
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | RAILROAD MC
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Identifier #2
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Identifier Code | 003131900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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Identifier #3
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Identifier Code | 322675
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | AETNA
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Identifier #4
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Identifier Code | 41923
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | BCBS
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 003131900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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Identifier #2
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Identifier Code | 110194124
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | RAILROAD MC
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Identifier #3
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Identifier Code | 322675
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | AETNA
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Identifier #4
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Identifier Code | 41923
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Identifier Type | OTHER
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Identifier State | FL
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Identifier Issuer | BCBS
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