MEDICARE: KATHERINE A HOLLOWAY LD

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	207VX0000X	Obstetrics Physician	1003381	OR

General Provider Information

NPI Number	:	1780863761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE A HOLLOWAY LD

Provider Business Mailing Address
First Line	:	4037 NE 8TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212
Country	:	US
Telephone Number	:	503-998-0252
Fax Number	:	503-239-4413

Provider Business Practice Location Address
First Line	:	4037 NE 8TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1208
Country	:	US
Telephone Number	:	503-998-0252
Fax Number	:	503-239-4413

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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