Provider Demographics
NPI:1609860196
Name:HOLLOWAY, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0615
Mailing Address - Country:US
Mailing Address - Phone:308-632-2872
Mailing Address - Fax:308-632-4191
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0615
Practice Address - Country:US
Practice Address - Phone:308-632-2872
Practice Address - Fax:308-632-4191
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20855208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070174412Medicaid
NE47070174412Medicaid
NEG69974Medicare UPIN