Provider Demographics
NPI:1336317205
Name:EARL L. HOLLOWAY, M.D., INC
Entity Type:Organization
Organization Name:EARL L. HOLLOWAY, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:510-654-7525
Mailing Address - Street 1:3318 ELM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3013
Mailing Address - Country:US
Mailing Address - Phone:510-654-7525
Mailing Address - Fax:510-654-7498
Practice Address - Street 1:3318 ELM ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3012
Practice Address - Country:US
Practice Address - Phone:510-654-7525
Practice Address - Fax:510-654-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18104207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40270Medicare UPIN
CA00G181040Medicare PIN