Provider Demographics
NPI:1255617627
Name:HOLLOMAN, DANIEL BENNETT
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BENNETT
Last Name:HOLLOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MILAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2718
Mailing Address - Country:US
Mailing Address - Phone:901-218-2524
Mailing Address - Fax:
Practice Address - Street 1:1110 MILAN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2718
Practice Address - Country:US
Practice Address - Phone:901-218-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist