Individual
EVERETT DEAN HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4262
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L6065
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158367610
—
TX
05
—
158367611
—
TX
05
—
158367612
—
TX
05
—
158367613
—
TX
05
—
158367614
—
TX
01
—
75-0818167-048
TRICARE
TX
01
—
75-0818167022
TRICARE
TX
01
—
75-2616977-002
TRICARE
TX
01
—
75-2616977-01
TRICARE
TX
01
—
75-2616977-028
TRICARE
TX
01
—
750818167015
TRICARE
TX
01
—
750818167044
TRICARE
TX
01
—
751976930005
TRICARE
TX
01
—
8DU752
BCBS
TX
01
—
8X8161
BCBS
TX
01
—
P00662854
RAIL ROAD
TX
01
—
P00792073
RAIL ROAD
TX
01
—
P01304462
RAIL ROAD
TX
01
—
TIN PLUS 015
TRICARE
TX
Enumeration date
07/10/2006
Last updated
11/06/2020
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