Organization
HOLBROOK FAMILY MEDICAL PRACTICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIP D HOLBROOK MD (OWNER)
(601) 847-3712
Entity
Organization
Contact information
Practice address
102 OAK ST, MENDENHALL, MS 39114-3650
(601) 847-3712
Mailing address
102 OAK ST, MENDENHALL, MS 39114-3650
(601) 847-3712
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14412
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015830
—
MS
01
—
587439330D
BLUE CROSS
MS
Enumeration date
02/19/2007
Last updated
04/08/2011
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