Provider Demographics
NPI:1932298288
Name:HOLEYFIELD, ROY WINFORD JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:WINFORD
Last Name:HOLEYFIELD
Suffix:JR
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 1:41935 VARDON DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:402-813-0279
Mailing Address - Fax:
Practice Address - Street 1:41935 VARDON DRIVE
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:402-813-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG081103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063291413Medicaid
G49440Medicare UPIN
NE47063291413Medicaid