Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G5179 | TX |
NPI | 1033179593 |
---|---|
Provider Name | Dr. Mark F. Hollingsworth |
First Address | Dallas, TX 75284-7408 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1343808-05 | CSHCN (01) | TX |
1343808-06 | (05) | TX |
180040813 | RR/MEDICARE (01) | TX |
85357F | BLUE SHIELD (01) | TX |
C17039 | (02) | TX |