Provider Demographics
NPI:1699875633
Name:HOLLIDAY, JOEL DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DAVID
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2704 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6378
Mailing Address - Country:US
Mailing Address - Phone:972-698-2090
Mailing Address - Fax:972-613-4178
Practice Address - Street 1:2704 N GALLOWAY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:214-660-2500
Practice Address - Fax:972-613-4178
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD3614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033232201Medicaid
TXP00733505OtherMEDICARE RAIL ROAD
TXP00733505OtherMEDICARE RAIL ROAD
TX033232201Medicaid