Provider Demographics
NPI:1225127574
Name:HOLEYFIELD, ROY W (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:W
Last Name:HOLEYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 S 25TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-292-3987
Mailing Address - Fax:402-292-4034
Practice Address - Street 1:10135 S 25TH ST
Practice Address - Street 2:STE A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-292-3987
Practice Address - Fax:402-292-4034
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063291413Medicaid
B68024Medicare UPIN
096355Medicare ID - Type Unspecified