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General NPI Number Information
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NPI Number | 1659427615
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Entity Type | Organization
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Legal Business Name | TOM HOLLEY, MD, INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 1216 ALCAZAR ST NE GOLDSMITH
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7108
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Country | US
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Telephone | 505-232-9516
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Fax | 505-232-9516
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Provider Business Mailing Address
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Address Line | 1216 ALCAZAR ST NE GOLDSMITH
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7108
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Country | US
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Telephone | 505-232-9516
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Fax | 505-232-9516
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Authorized Official
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Title or Position | OWNER, PSYCHIATRIST
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Name | DR. THOMAS R. HOLLEY
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Credential | MD
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Telephone | 505-232-9516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 77-45
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 77-45
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License Number State | NM
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