Provider Demographics
NPI:1417038738
Name:HOLLAR, LARRY ARRAY JR (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ARRAY
Last Name:HOLLAR
Suffix:JR
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:PROVIDER ENROLLMENT
Mailing Address - Street 2:100 KIMEL FOREST DRIVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:1188 YADKINVILLE RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2037
Practice Address - Country:US
Practice Address - Phone:367-167-4353
Practice Address - Fax:336-702-9277
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127R4OtherBLUE CROSS BLUE SHIELD
NC89127R4Medicaid
NC2280477FMedicare PIN
NC89127R4Medicaid
NCH21387Medicare UPIN