Provider Demographics
NPI:1053306134
Name:HOLIDAY MEDICAL ASSOCIATES P A
Entity Type:Organization
Organization Name:HOLIDAY MEDICAL ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-938-2474
Mailing Address - Street 1:4642 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-3906
Mailing Address - Country:US
Mailing Address - Phone:727-938-2474
Mailing Address - Fax:727-934-1579
Practice Address - Street 1:4642 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-3906
Practice Address - Country:US
Practice Address - Phone:727-938-2474
Practice Address - Fax:727-934-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38172Medicare ID - Type Unspecified