Individual
DR. CLIVE POLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 E 30TH ST, SUITE 107, AUSTIN, TX 78705-3326
(512) 476-9699
Mailing address
1601 TRINITY ST STOP Z0200, AUSTIN, TX 78712-1850
(512) 495-5512
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
K1001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035BJ
BCBS PROVIDER ID
TX
01
—
10007154
AMERIGROUP PROVIDER ID
TX
05
—
113461103
—
TX
Enumeration date
02/16/2006
Last updated
02/18/2019
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