Individual
JERROLD POLTEROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 S OAK AVE, SUITE 4, OAKDALE, CA 95361-3572
(209) 845-0100
(209) 845-0130
Mailing address
250 S OAK AVE, SUITE 4, OAKDALE, CA 95361-3572
(209) 845-0100
(209) 845-0130
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G16347
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G163471
—
CA
01
—
ZZZ07922Z
BLUE SHIELD
CA
Enumeration date
02/10/2006
Last updated
06/23/2011
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