Healthcare Provider Details

I. General information

NPI: 1205899457
Provider Name (Legal Business Name): WILLIAM A HOLLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 MAIN ST
BUFFALO NY
14214-2634
US

IV. Provider business mailing address

2162 MAIN ST
BUFFALO NY
14214-2634
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-9957
  • Fax: 716-834-5007
Mailing address:
  • Phone: 716-862-9957
  • Fax: 716-834-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: