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General NPI Number Information
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NPI Number | 1619905692
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Entity Type | Individual
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Provider Name | BRADLY SHANE HOLLAND DO
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 5208 W VILLAGE PKWY STE 1
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City | ROGERS
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State | AR
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Zip | 72758-8199
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Country | US
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Telephone | 479-389-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 W WOODVIEW
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City | ROGERS
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State | AR
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Zip | 72758-8084
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Country | US
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Telephone | 479-586-0984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E5111
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1639
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-5111
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License Number State | AR
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