Provider Demographics
NPI:1689451486
Name:HOLUB, JUSTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:HOLUB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 PENDLETON DR APT 5302
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2679
Mailing Address - Country:US
Mailing Address - Phone:713-254-9148
Mailing Address - Fax:
Practice Address - Street 1:4225 PENDLETON DR APT 5302
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2679
Practice Address - Country:US
Practice Address - Phone:713-254-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant