Provider Demographics
NPI:1871099499
Name:HOLLOWOA, BLAKE RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RYAN
Last Name:HOLLOWOA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:335 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1503
Mailing Address - Country:US
Mailing Address - Phone:615-342-0290
Mailing Address - Fax:615-342-0289
Practice Address - Street 1:9228 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9125
Practice Address - Country:US
Practice Address - Phone:843-574-5693
Practice Address - Fax:843-764-4512
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC89309207Y00000X
TN71712207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology