1316167133 NPI number — DR. HOLLY BROWNE MOLLGAARD DPM

Table of content: DR. HOLLY BROWNE MOLLGAARD DPM (NPI 1316167133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316167133 NPI number — DR. HOLLY BROWNE MOLLGAARD DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLGAARD
Provider First Name:
HOLLY
Provider Middle Name:
BROWNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWNE
Provider Other First Name:
HOLLY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316167133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15010 STONETOWER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78248-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-385-6959
Provider Business Mailing Address Fax Number:
830-620-6888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 MISSION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-6129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-625-8200
Provider Business Practice Location Address Fax Number:
830-620-6888
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1808 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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