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General NPI Number Information
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NPI Number | 1023392651
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Entity Type | Organization
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Legal Business Name | ROY W.HOLEYFIELD JR. M.D. P.C.
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 12717 S 28TH AVE
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City | BELLEVUE
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State | NE
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Zip | 68123-3232
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Country | US
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Telephone | 402-991-7071
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Fax | 402-292-7465
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Provider Business Mailing Address
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Address Line | 12717 S 28TH AVE
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City | BELLEVUE
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State | NE
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Zip | 68123-3232
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Country | US
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Telephone | 402-991-7071
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Fax | 402-292-7465
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROY W. HOLEYFIELD JR.
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Credential | M.D.
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Telephone | 402-991-7071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20728
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License Number State | NE
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