Provider Demographics
NPI:1508852021
Name:HOLLANDER, IRA NEIL (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:NEIL
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER RUN
Mailing Address - Street 2:SUITE 902
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6579
Mailing Address - Country:US
Mailing Address - Phone:817-332-8847
Mailing Address - Fax:817-332-3614
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 902
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-332-8847
Practice Address - Fax:817-332-3614
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8564208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129525507Medicaid
TX129525508Medicaid
TX129525509OtherMEDICAID OTHER
TX129525510Medicaid
TX129525506Medicaid
TX129525507Medicaid
TX8G0965Medicare PIN
TX129525508Medicaid