Provider Demographics
NPI:1306917117
Name:POLLOCK, JASON WAYNE (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WAYNE
Last Name:POLLOCK
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 1:1272 GARRISON DR.
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-867-7833
Mailing Address - Fax:615-848-1182
Practice Address - Street 1:1272 GARRISON DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2598
Practice Address - Country:US
Practice Address - Phone:615-867-7833
Practice Address - Fax:615-848-1182
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000256367173000000X
TNMD00000050049173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500062Medicaid
NVH89973Medicare UPIN
NV100500062Medicaid