Individual
DR. GERALD IRA POLUKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 N 500 E, LOGAN, UT 84341-2408
(435) 716-2200
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 716-2200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
370398-1205
UT
207RC0000X
Cardiovascular Disease Physician
M9904
ID
207RI0011X
Interventional Cardiology Physician
370398-1205
UT
207RI0011X
Interventional Cardiology Physician
M-9904
ID
Other
Enumeration date
10/02/2006
Last updated
06/20/2016
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