Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | Q5429 | TX |
NPI | 1003106766 |
---|---|
Provider Name | Jason B Holinbeck |
First Address | Wichita Falls, TX 76308-9261 |
Second Address | Wichita Falls, TX 76301-4323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 24/04/2019 |