Basic Information
| Provider Information | |||||||||
| NPI: | 1790724839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W HIGHWAY 6 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767105575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547767744 | ||||||||
| FaxNumber: | 2547519211 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W HIGHWAY 6 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767105575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547767744 | ||||||||
| FaxNumber: | 2547519211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | L3681 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 150412801 | 05 | TX | MEDICAID |