Provider Demographics
NPI:1790795110
Name:HOLADAY, HOWARD R (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:R
Last Name:HOLADAY
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 1:310 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8684
Mailing Address - Country:US
Mailing Address - Phone:601-842-9185
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST STE 420
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-355-3353
Practice Address - Fax:601-355-3365
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11213207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE14395Medicare UPIN