Individual
DAVID MICHAEL POLSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
650 JOEL DR, ATTENTION: CREDENTIALS OFFICE, FORT CAMPBELL, KY 42223-5318
(270) 798-8130
Mailing address
650 JOEL DR, ATTENTION: CREDENTIALS OFFICE, FORT CAMPBELL, KY 42223-5318
(270) 798-8130
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1103385
TN
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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