Healthcare Provider Details

I. General information

NPI: 1306809967
Provider Name (Legal Business Name): MR. DOUGLAS NEIL HOLLEMAN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MHC CREW INFLICT NAVAL STATION INGLESIDE
INGLESIDE TX
78362
US

IV. Provider business mailing address

2006 MCMULLEN LN
ARANSAS PASS TX
78336-4635
US

V. Phone/Fax

Practice location:
  • Phone: 361-776-5609
  • Fax:
Mailing address:
  • Phone: 361-758-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: