Provider Demographics
NPI:1326083999
Name:HOLLOS, LORI ANN (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:HOLLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N CENTRAL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2702
Mailing Address - Country:US
Mailing Address - Phone:970-820-5000
Mailing Address - Fax:970-820-5061
Practice Address - Street 1:2923 GINNALA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2702
Practice Address - Country:US
Practice Address - Phone:970-820-5000
Practice Address - Fax:970-820-5061
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72303743Medicaid
COHO43110OtherBCBS
COP00344909Medicare PIN
COC806278Medicare PIN
COI61310Medicare UPIN