Provider Demographics
NPI:1457315772
Name:HOLLMANN, MARK W (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:HOLLMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3282
Mailing Address - Country:US
Mailing Address - Phone:386-734-9122
Mailing Address - Fax:386-736-4348
Practice Address - Street 1:740 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3282
Practice Address - Country:US
Practice Address - Phone:386-734-9122
Practice Address - Fax:386-736-4348
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME52028207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0624049OtherAETNA NO
FL4017559007OtherCIGNA NO
FL10617OtherBLUE CROSS NO
FL063726200Medicaid
FL4017559007OtherCIGNA NO
FL10617OtherBLUE CROSS NO