MEDICARE: SANFORD ZACHARY POLLAK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	OS5198	FL

General Provider Information

NPI Number	:	1811097116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANFORD ZACHARY POLLAK D.O.

Provider Business Mailing Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BUILDING 11
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-636-7755
Fax Number	:	904-636-5885

Provider Business Practice Location Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BUILDING 11
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-636-7755
Fax Number	:	904-636-5885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/10/2010

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