Provider Demographics
NPI:1538137294
Name:HOLSOPPLE, MERLE RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:RAY
Last Name:HOLSOPPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-0102
Mailing Address - Country:US
Mailing Address - Phone:812-486-2842
Mailing Address - Fax:812-486-2784
Practice Address - Street 1:542 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47558-5745
Practice Address - Country:US
Practice Address - Phone:812-486-2842
Practice Address - Fax:812-486-2784
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057351A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200432660Medicaid
IN941190UUUUMedicare PIN
H84271Medicare UPIN
IN254690AMedicare PIN