Provider Demographics
NPI:1346285533
Name:HOLADAY, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:HOLADAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0310
Mailing Address - Country:US
Mailing Address - Phone:870-424-5079
Mailing Address - Fax:870-424-8455
Practice Address - Street 1:811 HWY 5 S
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639
Practice Address - Country:US
Practice Address - Phone:870-382-8118
Practice Address - Fax:870-382-8196
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134159001Medicaid
AR5K683Medicare ID - Type Unspecified
AR134159001Medicaid