Provider Demographics
NPI:1467443424
Name:HOLLIS, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:148 J C MAULDIN HIGHWAY
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0309
Mailing Address - Country:US
Mailing Address - Phone:256-757-5353
Mailing Address - Fax:256-757-9744
Practice Address - Street 1:148 J C MAULDIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645
Practice Address - Country:US
Practice Address - Phone:256-757-5353
Practice Address - Fax:256-757-9744
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL11228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891914362OtherGROUP NPI
AL63-0944359OtherTAX ID #
1891914362OtherGROUP NPI
ALC72363Medicare UPIN