Healthcare Provider Details

I. General information

NPI: 1023102886
Provider Name (Legal Business Name): DANIEL T HOLLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 SOUTH KANNER HIGHWAY
STUART FL
34994
US

IV. Provider business mailing address

2065 SOUTH KANNER HIGHWAY
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-0677
  • Fax: 772-286-6720
Mailing address:
  • Phone: 772-286-0677
  • Fax: 772-286-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME73391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: