Individual
JEFFREY LYNN HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6100 HARRIS PKWY STE 290, FORT WORTH, TX 76132-4127
(817) 433-5880
(817) 292-3627
Mailing address
6100 HARRIS PKWY STE 290, FORT WORTH, TX 76132-4127
(817) 433-5880
(817) 292-3627
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2003012712
MO
208600000X
Surgery Physician
Primary
Q2298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568492999
—
MO
05
—
200612550A
—
KS
01
—
P00735208
RR MEDICARE
MO
Enumeration date
07/03/2006
Last updated
08/18/2021
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