Provider Demographics
NPI:1902848088
Name:HOLLEY, ERIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10150 S CENTINNIAL PWKY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070
Mailing Address - Country:US
Mailing Address - Phone:801-662-3578
Mailing Address - Fax:801-662-3588
Practice Address - Street 1:100 N MARIO CAPECCHI DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113
Practice Address - Country:US
Practice Address - Phone:801-662-3578
Practice Address - Fax:801-662-3588
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6559721207LP3000X
WI46304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIBH8649270OtherDEA LICENSE
WIBH8649270OtherDEA LICENSE