1225287162 NPI number — DOROTHY M POLLAK DOTTIE POLLAK, MA

Table of content: DOROTHY M POLLAK DOTTIE POLLAK, MA (NPI 1225287162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225287162 NPI number — DOROTHY M POLLAK DOTTIE POLLAK, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLAK
Provider First Name:
DOROTHY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DOTTIE POLLAK, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLLAK
Provider Other First Name:
DOTTIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DOTTIE POLLAK
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225287162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97756-0113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-548-6166
Provider Business Mailing Address Fax Number:
541-548-6168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1379 SW 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-548-6166
Provider Business Practice Location Address Fax Number:
541-548-6168
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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