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General NPI Number Information
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NPI Number | 1720021314
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Entity Type | Individual
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Provider Name | MIKE PRINKEY JOLLIFFE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 1501 BURNET RD DEPT OF ANESTHESIOLOGY
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City | BROWNWOOD
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State | TX
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Zip | 76801-8520
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Country | US
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Telephone | 325-649-2070
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Fax | 325-649-3960
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Provider Business Mailing Address
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Address Line | 1501 BURNET RD
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City | BROWNWOOD
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State | TX
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Zip | 76801-8520
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Country | US
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Telephone | 325-649-2070
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Fax | 325-649-3960
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | L5393
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License Number State | TX
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