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General NPI Number Information
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NPI Number | 1447258157
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Entity Type | Individual
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Provider Name | JOHN ALAN HOLLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 708 HIGHWAY 142
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City | LYLE
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State | WA
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Zip | 98635-9111
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Country | US
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Telephone | 509-365-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2603 212 N 3RD STREET
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City | MCCALL
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State | ID
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Zip | 83638
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Country | US
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Telephone | 208-315-4390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-11371
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License Number State | ID
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