Provider Demographics
NPI:1548292360
Name:HOLLOWAY, LISA ROBIN (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROBIN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ROBIN
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 400 MOB3
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2345
Mailing Address - Country:US
Mailing Address - Phone:281-275-0800
Mailing Address - Fax:281-275-0801
Practice Address - Street 1:2150 W 18TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1289
Practice Address - Country:US
Practice Address - Phone:713-426-0027
Practice Address - Fax:713-426-0211
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3341207P00000X, 207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158222305Medicaid
TXP00846068OtherMEDICARE RAILROAD
TX158222304Medicaid
TXP01030998OtherRR MEDICARE
TX1548292360OtherBLUE CROSS BLUE SHIELD
TX1548292360OtherBLUE CROSS BLUE SHIELD
TX158222305Medicaid
TXP00846068OtherMEDICARE RAILROAD
TXH50320Medicare UPIN