Individual
JORGE POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
262 LEROY GEORGE DR, CLYDE, NC 28721-7430
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 60274, CHARLOTTE, NC 28260-0274
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200201300
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1323K
BCBS
NC
05
—
891323K
—
NC
01
—
P00201238
RAILROAD
NC
Enumeration date
01/27/2006
Last updated
03/17/2009
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