Individual
KEITH G HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4424 E FLAMINGO AVE, SUITE 110, NAMPA, ID 83687
(208) 288-4700
(208) 288-4720
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
M-11367
ID
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
MD00045579
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386616183
—
ID
Enumeration date
02/06/2006
Last updated
10/22/2014
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