Provider Demographics
NPI:1679533129
Name:HOLLAND-BARKIS, PENELOPE A (MD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:A
Last Name:HOLLAND-BARKIS
Suffix:
Gender:F
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7408
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1907
Practice Address - Country:US
Practice Address - Phone:254-933-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87190NOtherBLUE SHIELD
TX0485997-01OtherCSHCN
TX080161348OtherRR/MEDICARE
TX1053720-02Medicaid
TXG90929Medicare UPIN
TX87190NMedicare ID - Type Unspecified