Provider Demographics
NPI:1982612149
Name:BOLLINGER, HIRAM JEFFREY (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:HIRAM
Middle Name:JEFFREY
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COLINA CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-1224
Mailing Address - Country:US
Mailing Address - Phone:940-632-8441
Mailing Address - Fax:
Practice Address - Street 1:1800 7TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4204
Practice Address - Country:US
Practice Address - Phone:940-723-2373
Practice Address - Fax:940-723-1892
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0130262OtherCONTROLLED SUB LICENSE
MB1052733OtherFEDERAL DEA NUMBER
TXR0130262OtherCONTROLLED SUB LICENSE