Provider Demographics
NPI:1982648366
Name:HOLLUB, ALEXANDER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:HOLLUB
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 1:301 E. OVILLA ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3833
Mailing Address - Country:US
Mailing Address - Phone:972-617-5225
Mailing Address - Fax:972-617-7922
Practice Address - Street 1:301 E. OVILLA ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3833
Practice Address - Country:US
Practice Address - Phone:972-617-5225
Practice Address - Fax:972-617-7922
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099146504Medicaid
TX8BR065OtherBCBS
TX0991465-03Medicaid
TX81830SOtherBCBS
TXP00721849Medicare PIN
TX8F9773Medicare PIN
TX8F3681Medicare PIN
TX81830SOtherBCBS
TX080124042Medicare PIN