Provider Demographics
NPI:1649451014
Name:LARRY POLINER, MD, PA
Entity type:Organization
Organization Name:LARRY POLINER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-8477
Mailing Address - Street 1:7777 FOREST LN STE C600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2517
Mailing Address - Country:US
Mailing Address - Phone:972-566-8477
Mailing Address - Fax:972-566-8488
Practice Address - Street 1:7777 FOREST LN STE C600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2517
Practice Address - Country:US
Practice Address - Phone:972-566-8477
Practice Address - Fax:972-566-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649451014OtherNPI
TX0007BRMedicare PIN