Healthcare Provider Details

I. General information

NPI: 1396748729
Provider Name (Legal Business Name): ROGER E. HOLLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL PARK DR
ASHEVILLE NC
28803-2493
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-8232
  • Fax:
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number9601339
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: