Provider Demographics
NPI:1881696011
Name:HOLLEY, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 295W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6360
Mailing Address - Fax:406-238-6361
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:STE 295W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6360
Practice Address - Fax:406-238-6361
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT4088207ZP0102X, 207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT51675Medicaid
D96288Medicare UPIN
MT1831Medicare ID - Type Unspecified
MT220018140Medicare PIN