Basic Information
| Provider Information | |||||||||
| NPI: | 1750802229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLLOCK | ||||||||
| FirstName: | CODY | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 19TH AVE EAST | ||||||||
| Address2: | APARTMENT 301 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036403034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1959 NORTHEAST PACIFIC STREET, | ||||||||
| Address2: | BOX 357115 UNIVERSITY OF WASHINGTON MEDICAL CENTER | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065985130 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2017 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | WA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.