Healthcare Provider Details

I. General information

NPI: 1962793877
Provider Name (Legal Business Name): NATHAN J HOLLOWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S ASPEN ST
BUCKLEY AFB CO
80011-9562
US

IV. Provider business mailing address

275 S ASPEN ST
BUCKLEY AFB CO
80011-9562
US

V. Phone/Fax

Practice location:
  • Phone: 720-847-6476
  • Fax:
Mailing address:
  • Phone: 719-526-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27217
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0071235
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2016-00409
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21318
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberDR.0071235
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME133632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: