Healthcare Provider Details

I. General information

NPI: 1720530355
Provider Name (Legal Business Name): ROBERT HOLLY D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 REILLY RD BLDG 2
FORT BRAGG NC
28307
US

IV. Provider business mailing address

184 CENTURY DR
CAMERON NC
28326-4001
US

V. Phone/Fax

Practice location:
  • Phone: 910-396-9120
  • Fax:
Mailing address:
  • Phone: 706-424-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberVET009208
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: