Individual
MARK E HOLLINGSHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
360 E MALLARD DR, STE 110, BOISE, ID 83706-3945
(208) 336-8700
(208) 426-0902
Mailing address
360 E MALLARD DR, STE 110, BOISE, ID 83706-3945
(208) 336-8700
(208) 426-0902
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M6436
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0030470
—
ID
Enumeration date
06/22/2005
Last updated
04/08/2008
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