Provider Demographics
NPI:1023392651
Name:ROY W.HOLEYFIELD JR. M.D. P.C.
Entity Type:Organization
Organization Name:ROY W.HOLEYFIELD JR. M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLEYFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:402-991-7071
Mailing Address - Street 1:12717 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3232
Mailing Address - Country:US
Mailing Address - Phone:402-991-7071
Mailing Address - Fax:402-292-7465
Practice Address - Street 1:12717 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3232
Practice Address - Country:US
Practice Address - Phone:402-991-7071
Practice Address - Fax:402-292-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty