Provider Demographics
NPI:1831298355
Name:HOLLOWAY, ALBERT Z (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:Z
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-420-5001
Mailing Address - Fax:334-420-0158
Practice Address - Street 1:2611 WOODLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3834
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:334-420-0158
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL83182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000009675Medicaid
AL110466Medicaid
AL000009675Medicaid
ALC76709Medicare UPIN