Provider Demographics
NPI:1790786481
Name:HOLYFIELD, PAUL ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALFRED
Last Name:HOLYFIELD
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 1:315 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1945
Mailing Address - Country:US
Mailing Address - Phone:276-638-8881
Mailing Address - Fax:276-638-3268
Practice Address - Street 1:315 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1945
Practice Address - Country:US
Practice Address - Phone:276-638-8881
Practice Address - Fax:276-638-3268
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-028353207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006242731Medicaid
VA161951837Medicare ID - Type Unspecified
VAB05377Medicare UPIN