Provider Demographics
NPI:1871789479
Name:HOLLY KNUDSEN VARNER, MD PA
Entity type:Organization
Organization Name:HOLLY KNUDSEN VARNER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:281-335-4726
Mailing Address - Street 1:1322 SPACE PARK DR
Mailing Address - Street 2:#A194
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3400
Mailing Address - Country:US
Mailing Address - Phone:281-335-4601
Mailing Address - Fax:281-335-4685
Practice Address - Street 1:1322 SPACE PARK DR
Practice Address - Street 2:#A194
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3400
Practice Address - Country:US
Practice Address - Phone:281-335-4601
Practice Address - Fax:281-335-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0330207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W429Medicare UPIN