MEDICARE: MARK THOMAS HOLLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	36330	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588673107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK THOMAS HOLLEY M.D.

Provider Business Mailing Address
First Line	:	2227 WEST 35TH AVE.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-0815
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 WEST 35TH AVE.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-0815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/30/2021

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