Individual
DR. BRONDWYN HOLLIWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3824 HEARNE AVE, SHREVEPORT, LA 71103-4328
(318) 635-8606
(318) 635-1265
Mailing address
3824 HEARNE AVE, SHREVEPORT, LA 71103-4328
(318) 635-8606
(318) 635-1265
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021100
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1449423
GROUP NUMBER
LA
05
—
1966207
—
LA
Enumeration date
03/13/2007
Last updated
07/08/2007
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