Provider Demographics
NPI:1023111259
Name:HOLLY, JASON SCOTT LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:JASON SCOTT
Middle Name:LAWRENCE
Last Name:HOLLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-241-3338
Mailing Address - Fax:816-936-8118
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 420
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-241-3338
Practice Address - Fax:816-936-8118
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012023678207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology