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General NPI Number Information
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NPI Number | 1780023192
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Entity Type | Organization
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Legal Business Name | HOLLAND SURGICAL GROUP
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 201 WEST TARRANT RD. #1420
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050
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Country | US
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Telephone | 469-684-1578
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 532175
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City | GRAND PRAIRIE
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State | TX
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Zip | 75053
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Country | US
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Telephone | 469-684-1578
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Fax | 214-677-0079
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Authorized Official
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Title or Position | SURGICAL FIRST ASSISTANT
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Name | MR. PRESCOTT BENTON HOLLAND
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Credential |
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Telephone | 469-684-1578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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