Provider Demographics
NPI:1700848983
Name:HOLLEY, LAURIE S (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:ONE BAYLOR PLAZA
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:281-554-7031
Mailing Address - Fax:832-355-4232
Practice Address - Street 1:4600 E SAM HOUSTON PKWY SOUTH
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:713-785-8357
Practice Address - Fax:713-798-5838
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6495207ZP0102X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102336803Medicaid
TX102336802Medicaid
G95527Medicare UPIN