Individual
DR. HOLLY A. VANCLEAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1608 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K5730
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1054603-01
—
TX
01
—
1054603-02
CSHCN
TX
01
—
110210858
RR/MEDICARE
TX
01
—
81754Y
BLUE SHIELD
TX
Enumeration date
04/03/2006
Last updated
03/31/2022
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