Provider Demographics
NPI:1053335372
Name:HOLLIDAY, HARRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2163
Mailing Address - Country:US
Mailing Address - Phone:662-615-2503
Mailing Address - Fax:662-615-2554
Practice Address - Street 1:107 BRANDON RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2521
Practice Address - Country:US
Practice Address - Phone:662-324-1291
Practice Address - Fax:662-324-2196
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS17672207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00200336Medicaid
MSI65030Medicare UPIN
MS00200336Medicaid