Provider Demographics
NPI:1699323600
Name:POLLEY, BEAU DODD
Entity type:Individual
Prefix:MR
First Name:BEAU
Middle Name:DODD
Last Name:POLLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MELROSE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4405
Mailing Address - Country:US
Mailing Address - Phone:469-998-4544
Mailing Address - Fax:
Practice Address - Street 1:331 MELROSE DR STE 240
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4405
Practice Address - Country:US
Practice Address - Phone:469-998-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide