Provider Demographics
NPI:1396999256
Name:JERRY T HOLUBEC DO, PA
Entity type:Organization
Organization Name:JERRY T HOLUBEC DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOLUBEC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-672-8921
Mailing Address - Street 1:PO BOX 268969
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8969
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:
Practice Address - Street 1:2710 N JOSEY LN
Practice Address - Street 2:STE 301
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5400
Practice Address - Country:US
Practice Address - Phone:469-916-0521
Practice Address - Fax:972-231-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0458208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20221Medicare UPIN