=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982753620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRY R POLLOCK, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 01/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4642 N LOOP 289 STE 105
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-771-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4642 N LOOP 289 STE 105
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-771-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GARRY R POLLOCK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 806-771-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | J0204
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------