Provider Demographics
NPI:1518086511
Name:DUBOIS, HOLLY COLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:COLLEEN
Last Name:DUBOIS
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:PO BOX 6512
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-0512
Mailing Address - Country:US
Mailing Address - Phone:210-464-2541
Mailing Address - Fax:210-579-9223
Practice Address - Street 1:8026 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-575-8229
Practice Address - Fax:866-368-3235
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA965872084P0800X
TXN50242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212570001Medicaid
TX212570002Medicaid
TXP00951157OtherRAILROAD
8CU834OtherBCBS TX
TX8CG227OtherBCBSTX
TX8L27033Medicare PIN
TX212570002Medicaid