MEDICARE: DR. JONATHAN POLLACK MD

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	208200000X	Plastic Surgery Physician	2004002424	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00283056	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972572360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN POLLACK MD

Provider Business Mailing Address
First Line	:	701 S NEW BALLAS RD STE 310
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8725
Country	:	US
Telephone Number	:	314-251-8750
Fax Number	:	314-251-8751

Provider Business Practice Location Address
First Line	:	701 S NEW BALLAS RD STE 310
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8725
Country	:	US
Telephone Number	:	314-251-8750
Fax Number	:	314-251-8751

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/06/2023

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