Provider Demographics
NPI:1750300760
Name:HOLLOWAY, DAVID H JR
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:HOLLOWAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:H
Other - Last Name:HOLLOWAY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8060 WOLF RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1727
Mailing Address - Country:US
Mailing Address - Phone:901-271-2272
Mailing Address - Fax:901-271-2161
Practice Address - Street 1:8060 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-1727
Practice Address - Country:US
Practice Address - Phone:901-271-2272
Practice Address - Fax:901-271-2161
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000004503207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3145469Medicaid
TN3145469Medicaid
TN3145460Medicare ID - Type Unspecified