Provider Demographics
NPI:1447247952
Name:POLINER, LAWRENCE RICHARD (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:POLINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-8477
Mailing Address - Fax:469-484-6197
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-8477
Practice Address - Fax:469-484-6197
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5206207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079799501Medicaid
TX1447247952OtherNPI
TX1447247952OtherNPI
TX83630FMedicare PIN