Provider Demographics
NPI:1528384401
Name:PETER WILSON HOLLIMON M.D. PA
Entity Type:Organization
Organization Name:PETER WILSON HOLLIMON M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:HOLLIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-654-4583
Mailing Address - Street 1:8534 VILLAGE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5501
Mailing Address - Country:US
Mailing Address - Phone:210-654-4583
Mailing Address - Fax:210-654-8332
Practice Address - Street 1:8534 VILLAGE DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5501
Practice Address - Country:US
Practice Address - Phone:210-654-4583
Practice Address - Fax:210-654-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOBPO7Medicare UPIN