Provider Demographics
NPI:1407293442
Name:HOLLYFIELD, JOHNATHAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:MARTIN
Last Name:HOLLYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11025 RCA CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4269
Mailing Address - Country:US
Mailing Address - Phone:561-383-3820
Mailing Address - Fax:855-369-2450
Practice Address - Street 1:343 ELM ST STE 206
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-746-3400
Practice Address - Fax:775-746-3411
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC192214207ZP0102X
NV17859207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty