Provider Demographics
NPI:1447258157
Name:HOLLEY, JOHN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:HOLLEY
Suffix:
Gender:M
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:PO BOX 2603
Mailing Address - Street 2:212 N 3RD STREET
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638
Mailing Address - Country:US
Mailing Address - Phone:208-315-4390
Mailing Address - Fax:
Practice Address - Street 1:708 HIGHWAY 142
Practice Address - Street 2:
Practice Address - City:LYLE
Practice Address - State:WA
Practice Address - Zip Code:98635-9111
Practice Address - Country:US
Practice Address - Phone:509-365-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine