Provider Demographics
NPI:1710069885
Name:POLLARD, THOMAS WELDON (DO)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WELDON
Last Name:POLLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13634 N 93RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4915
Mailing Address - Country:US
Mailing Address - Phone:623-933-0301
Mailing Address - Fax:623-933-0224
Practice Address - Street 1:13634 N 93RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4915
Practice Address - Country:US
Practice Address - Phone:623-933-0301
Practice Address - Fax:623-933-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS0671207RP1001X
AZ008834207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ088194Medicaid
HI500745Medicaid
HI0229110OtherBCBS
HI500745Medicaid
H37012Medicare UPIN