MEDICARE: DR. LEAH HOLLY D.O.

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	207P00000X	Emergency Medicine Physician	H4416	TX
2	207Q00000X	Family Medicine Physician	H4416	TX

General Provider Information

NPI Number	:	1871969667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH HOLLY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 720639
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75372-0639
Country	:	US
Telephone Number	:	214-824-0890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 YOUNG ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-5433
Country	:	US
Telephone Number	:	214-824-0890
Fax Number	:

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

Provider Enumeration Date	:	08/15/2015
Last Update Date	:	08/15/2015

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Directions to “ DR. LEAH HOLLY D.O.” Practice Location

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