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General NPI Number Information
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NPI Number | 1104086966
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CLINIC OF MESQUITE, PA
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 2540 N GALLOWAY AVE SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150-6306
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Country | US
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Telephone | 972-279-6595
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Fax | 972-613-3737
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Provider Business Mailing Address
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Address Line | 2540 N GALLOWAY AVE SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150-6306
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Country | US
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Telephone | 972-279-6595
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Fax | 972-613-3737
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Authorized Official
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Title or Position | OWNER
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Name | JOEL D. HOLLIDAY
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Credential | D.O.
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Telephone | 972-279-6595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D3614
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License Number State | TX
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