Mark J Hollis, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

15 Santa Rosa Street
San Luis Obispo, CA 93405-1811

Phone

(805) 541-2650

Fax

(805) 541-4043

NPI assigned

Mar 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Mark J Hollis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• R Jeffrey Herten MD Inc

  • Dermatology Physician
  • San Luis Obispo, CA
  • NPI 1730279944
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1902873748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA STREET",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650",
            "fax_number": "805-541-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA STREET",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650",
            "fax_number": "805-541-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIS",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "HOLLIS",
            "middle_name": "J",
            "prefix": "MR.",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jason C Holland
• Justin Dwayne Holland
• Rita Marie Holland
• Jacob Holle
• Ryan Jason Holliday
• Jeffrey Lee Hollister, DDS
• Jon Edwin Hollister, DDS
• Lee Frazier Hollister, DDS
• Courtney Holloway
• Erika Holloway

• Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.