Provider Demographics
NPI:1205275617
Name:HOLLAND, PRESCOTT BENTON
Entity type:Individual
Prefix:MR
First Name:PRESCOTT
Middle Name:BENTON
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532175
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053
Mailing Address - Country:US
Mailing Address - Phone:469-684-1578
Mailing Address - Fax:214-677-0079
Practice Address - Street 1:201 W TARRANT RD APT 1420
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3583
Practice Address - Country:US
Practice Address - Phone:469-684-1578
Practice Address - Fax:214-677-0079
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical