Provider Demographics
NPI:1295780534
Name:HOLLEY, LISA M (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 N JOSEY LN STE 116-323
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2992
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:469-791-9228
Practice Address - Street 1:2145 N JOSEY LN STE 116-323
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2992
Practice Address - Country:US
Practice Address - Phone:817-516-8811
Practice Address - Fax:369-791-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4414207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137147812Medicaid
TX137147812Medicaid
TX8935MOMedicare PIN