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Individual

GREG A GOLLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
4041 W WHEATLAND RD, 156 343, DALLAS, TX 75237-4064
(972) 223-7878
(972) 283-0284
Mailing address
4041 W WHEATLAND RD, 156 343, DALLAS, TX 75237-4064
(972) 223-7878
(972) 283-0284

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
501795
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
109937604
TX
05
109937607
TX
05
109937608
TX
05
109937609
TX
01
8855UA
BCBS
TX
Enumeration date
12/07/2005
Last updated
01/29/2016
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