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General NPI Number Information
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NPI Number | 1568492999
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Entity Type | Individual
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Provider Name | JEFFREY LYNN HOLLOWAY DO
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6100 HARRIS PKWY STE 290
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City | FORT WORTH
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State | TX
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Zip | 76132-4127
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Country | US
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Telephone | 817-433-5880
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Fax | 817-292-3627
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Provider Business Mailing Address
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Address Line | 6100 HARRIS PKWY STE 290
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City | FORT WORTH
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State | TX
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Zip | 76132-4127
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Country | US
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Telephone | 817-433-5880
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Fax | 817-292-3627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2003012712
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | Q2298
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License Number State | TX
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