Provider Demographics
NPI:1023102886
Name:HOLLEY, DANIEL T (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2065 SOUTH KANNER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-286-0677
Mailing Address - Fax:772-286-6720
Practice Address - Street 1:2065 SOUTH KANNER HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-286-0677
Practice Address - Fax:772-286-6720
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73391208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650921418OtherFIRST HEALTH
FL650921418OtherWEB TPA
FL720838OtherCIGNA
FL0005673558OtherAETNA
FL41373OtherBC BS OF FLORIDA
FL650921418OtherONE SOURCE HEALTH NETWORK
FL650921418OtherTRICARE
FL240006528OtherRAILROAD MEDICARE
FL650921418OtherPHCS
FL41373OtherBC BS OF FLORIDA
FL0005673558OtherAETNA