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General NPI Number Information
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NPI Number | 1659199388
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Entity Type | Organization
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Legal Business Name | B SHANE HOLLAND, DO, PLLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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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 | 405-714-1733
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | BRADLY SHANE HOLLAND
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Credential | DO
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Telephone | 479-389-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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