Provider Demographics
NPI:1215013552
Name:HOLLIS, MINOO H (MD)
Entity Type:Individual
Prefix:
First Name:MINOO
Middle Name:H
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:5147 N 9TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8770
Practice Address - Country:US
Practice Address - Phone:850-494-9000
Practice Address - Fax:850-416-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68641207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59021560OtherBCBS AL
FL378013900Medicaid
FL27283OtherBCBS FL
FL593629735OtherTRICARE
162681500OtherACS
G13252Medicare UPIN
FL593629735OtherTRICARE