Provider Demographics
NPI:1104803717
Name:CEARLEY, HOLLY A (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:CEARLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2415
Mailing Address - Country:US
Mailing Address - Phone:512-901-4016
Mailing Address - Fax:512-901-3948
Practice Address - Street 1:2400 CEDAR BEND DR.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2483
Practice Address - Country:US
Practice Address - Phone:512-901-4016
Practice Address - Fax:512-901-3948
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6313208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160074401Medicaid
TX160074401Medicaid
TXH91772Medicare UPIN
TXTXB104970Medicare PIN