Provider Demographics
NPI:1154407823
Name:HOLLEY, GREGORY F (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1830 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4275
Mailing Address - Country:US
Mailing Address - Phone:970-945-8503
Mailing Address - Fax:970-947-9048
Practice Address - Street 1:707 NORTH TAYLOR
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-641-1399
Practice Address - Fax:970-641-9017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA1940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ51976Medicare ID - Type Unspecified