Provider Demographics
NPI:1760658009
Name:HOLLY, EUGENE H (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:H
Last Name:HOLLY
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 1:3336 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-4916
Mailing Address - Country:US
Mailing Address - Phone:561-284-5089
Mailing Address - Fax:561-845-1002
Practice Address - Street 1:3336 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-4916
Practice Address - Country:US
Practice Address - Phone:561-845-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0015138OtherSTATE LICENSE
FLAH2249399OtherDEA