Provider Demographics
NPI:1720530355
Name:HOLLY, ROBERT (DVM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:HOLLY
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-4001
Mailing Address - Country:US
Mailing Address - Phone:706-424-3531
Mailing Address - Fax:
Practice Address - Street 1:7606 REILLY RD
Practice Address - Street 2:BLDG 2
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307
Practice Address - Country:US
Practice Address - Phone:910-396-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAVET009208171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider