Healthcare Provider Details

I. General information

NPI: 1225015696
Provider Name (Legal Business Name): PAUL S HOLLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4936 MAIN ST
BEMUS POINT NY
14712-9667
US

IV. Provider business mailing address

4936 MAIN ST PO BOX 470
BEMUS POINT NY
14712-9667
US

V. Phone/Fax

Practice location:
  • Phone: 716-386-2414
  • Fax: 716-386-2437
Mailing address:
  • Phone: 716-386-2414
  • Fax: 716-386-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: