Healthcare Provider Details

I. General information

NPI: 1043319940
Provider Name (Legal Business Name): SHANE E. HOLLOWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S COULTER ST STE 200
AMARILLO TX
79106-1841
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-6604
  • Fax: 806-212-0355
Mailing address:
  • Phone: 806-212-6965
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL5771
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberL5771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: