Provider Demographics
NPI:1437284080
Name:DANIEL T HOLLEY MD PA
Entity Type:Organization
Organization Name:DANIEL T HOLLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-286-0677
Mailing Address - Street 1:2065 SOUTH KANNER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-286-0677
Mailing Address - Fax:772-286-6720
Practice Address - Street 1:2065 SOUTH KANNER HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-286-0677
Practice Address - Fax:772-286-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73391208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41373OtherBLUE CROSS BLUE SHIELD FL
FL240006528OtherRAILROAD MEDICARE
FL720838OtherCIGNA
FL0005673558OtherAETNA
FL=========OtherWEB TPA
FL=========OtherTRICARE
FL240006528OtherRAILROAD MEDICARE
FL41373OtherBLUE CROSS BLUE SHIELD FL
FL=========OtherONE SOURCE HEALTH NETWORK
FL=========OtherFIRST HEALTH
FL=========OtherWEB TPA