Provider Demographics
NPI:1922003862
Name:HOLLOWAY, EARL LOUIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:LOUIS
Last Name:HOLLOWAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3318 ELM SREET SUITE 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3013
Mailing Address - Country:US
Mailing Address - Phone:510-654-7525
Mailing Address - Fax:510-654-7498
Practice Address - Street 1:3318 ELM ST
Practice Address - Street 2:STE 2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3013
Practice Address - Country:US
Practice Address - Phone:510-654-7525
Practice Address - Fax:510-654-7498
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G181040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G181040Medicaid
CA00G181040Medicaid
CA00G181040Medicare ID - Type Unspecified