Provider Demographics
NPI:1346328622
Name:HOLLEY, BYRON EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:EDWARD
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6334
Mailing Address - Country:US
Mailing Address - Phone:813-681-1456
Mailing Address - Fax:813-684-6451
Practice Address - Street 1:1011 CHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6334
Practice Address - Country:US
Practice Address - Phone:813-681-1456
Practice Address - Fax:813-684-6451
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17077207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53746Medicare UPIN
FL29823Medicare ID - Type Unspecified