Provider Demographics
NPI:1568651586
Name:HOLLEY, ROBB WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:WARREN
Last Name:HOLLEY
Suffix:
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:873 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8113
Practice Address - Country:US
Practice Address - Phone:813-643-8300
Practice Address - Fax:813-443-8133
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58322OtherBLUE CROSS BLUE SHIELD
FL000326700Medicaid
FL000326700Medicaid
FLAO692YMedicare PIN