Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 1268 | AR |
Y | 111NN0400X | Neurology | 7230 | TX |
NPI | 1043320286 |
---|---|
Provider Name | Brooks Holifield |
First Address | Kingsville, TX 78364-1214 |
Second Address | Kingsville, TX 78363-6363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1789216-01 | (05) | TX |
606274 | BCBS (01) | TX |
U38596 | (02) | TX |