Provider Demographics
NPI:1588619043
Name:BASTIAN, HOLLY M (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:BASTIAN FRANCIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1201 ARISTA DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6860
Mailing Address - Country:US
Mailing Address - Phone:972-664-0644
Mailing Address - Fax:972-664-0301
Practice Address - Street 1:1201 ARISTA DR STE 105
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6860
Practice Address - Country:US
Practice Address - Phone:972-664-0644
Practice Address - Fax:972-664-0301
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083639A207RR0500X
AL17322207RR0500X
MT0001699207RR0500X
TXQ9950207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000042537OtherHEALTHSPRING
AL660000333OtherRAILROAD MEDICARE
AL000085151Medicaid
AL000085151OtherBLUE CROSS
ALF42171OtherVIVA
AL000085151OtherBLUE CROSS