Provider Demographics
NPI:1235574641
Name:HOLLOWAY, TRAVIS (DPM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 10TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3175
Mailing Address - Country:US
Mailing Address - Phone:830-393-1400
Mailing Address - Fax:830-393-1739
Practice Address - Street 1:497 10TH ST STE 104
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3178
Practice Address - Country:US
Practice Address - Phone:830-393-1400
Practice Address - Fax:830-393-1739
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2201213E00000X
TX2201213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist