Provider Demographics
NPI:1962484329
Name:BURGGRAF, HOLLIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLIS
Middle Name:A
Last Name:BURGGRAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:TRIPP
Other - Last Name:BURGGRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:800-997-6196
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:800-997-6196
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170137207Q00000X
CO42895207Q00000X
WI107-320207Q00000X
MTMED-PHYS-LIC-35639207Q00000X
NMMD2014-0872207Q00000X
MO2014040818207Q00000X
WY9939A207Q00000X
AZ25625207Q00000X
NV15656207Q00000X
IDM-12722207Q00000X
MN63507207Q00000X
HIMD-17921207Q00000X
IL036145467207Q00000X
WAMD60510290207Q00000X
CAA68380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ393116Medicaid
AZ25625OtherAZ LICENSE
CO43272541Medicaid
CO840255530056OtherROCKY MTN HEALTH PLANS
COP00423070OtherMEDICARE RAILROAD CARRIER
COG53967Medicare UPIN
AZ393116Medicaid
CO43272541Medicaid