Provider Demographics
NPI:1720021314
Name:JOLLIFFE, MIKE PRINKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:PRINKEY
Last Name:JOLLIFFE
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 1:1501 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-8520
Mailing Address - Country:US
Mailing Address - Phone:325-649-2070
Mailing Address - Fax:325-649-3960
Practice Address - Street 1:1501 BURNET RD
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-8520
Practice Address - Country:US
Practice Address - Phone:325-649-2070
Practice Address - Fax:325-649-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5393207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163968401Medicaid
TX8V0639OtherBCBSTX
TX163968402Medicaid
TX163968402Medicaid
TX8V0639OtherBCBSTX
TX163968401Medicaid