Provider Demographics
NPI:1932155298
Name:HOLLIE, NORRIS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORRIS
Middle Name:
Last Name:HOLLIE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NORRIS
Other - Middle Name:
Other - Last Name:HOLLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3315 ALMADEN EXPY STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1557
Mailing Address - Country:US
Mailing Address - Phone:408-264-6644
Mailing Address - Fax:
Practice Address - Street 1:3315 ALMADEN EXPY STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1557
Practice Address - Country:US
Practice Address - Phone:408-264-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA381572084P0800X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38157OtherMEDICAL LICENSE
CACK685ZMedicare UPIN
CAZZZ07334ZMedicare PIN