MEDICARE: JEFFREY LYNN HOLLOWAY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2003012712	MO
2	208600000X	Surgery Physician	Q2298	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00735208	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568492999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY LYNN HOLLOWAY DO

Provider Business Mailing Address
First Line	:	6100 HARRIS PKWY STE 290
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4127
Country	:	US
Telephone Number	:	817-433-5880
Fax Number	:	817-292-3627

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY STE 290
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4127
Country	:	US
Telephone Number	:	817-433-5880
Fax Number	:	817-292-3627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/18/2021

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Directions to “ JEFFREY LYNN HOLLOWAY DO” Practice Location

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