Provider Demographics
NPI:1174671812
Name:HOLE, DONALD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:HOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 E STOWELL RD
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7010
Mailing Address - Country:US
Mailing Address - Phone:805-934-5140
Mailing Address - Fax:805-934-3500
Practice Address - Street 1:1145 E CLARK AVE STE F
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5169
Practice Address - Country:US
Practice Address - Phone:805-934-5140
Practice Address - Fax:805-934-3500
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE96484Medicare UPIN
CAWG71933KMedicare PIN