Provider Demographics
NPI:1396784658
Name:HOLLAND, WESLEY REX (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:REX
Last Name:HOLLAND
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-0190
Mailing Address - Country:US
Mailing Address - Phone:843-815-6411
Mailing Address - Fax:843-815-6416
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-681-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT215742085R0202X
SC117602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC117607Medicaid
SC117607Medicaid
SCE113973966Medicare ID - Type UnspecifiedMEDICARE PROIVDER NUMBER
SCE113972939Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER