Provider Demographics
NPI:1902805500
Name:POLLARY, RODNEY A (MD)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:A
Last Name:POLLARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 N DESERT FOREST LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6520
Mailing Address - Country:US
Mailing Address - Phone:801-885-0309
Mailing Address - Fax:435-789-7754
Practice Address - Street 1:2978 N DESERT FOREST LN
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6520
Practice Address - Country:US
Practice Address - Phone:801-885-0309
Practice Address - Fax:801-823-0784
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158042-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16670013Medicaid
UT008955005OtherUTAH DRIVER'S LICENSE