MEDICARE: DR. ROBERT C. HOLLADAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD.020136	LA
2	207RP1001X	Pulmonary Disease Physician	020136	LA
3	207R00000X	Internal Medicine Physician	MD.020136	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124023668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C. HOLLADAY M.D.

Provider Business Mailing Address
First Line	:	850 OLIVE ST
Second Line	:	STE A
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2162
Country	:	US
Telephone Number	:	318-222-3662
Fax Number	:	318-222-0034

Provider Business Practice Location Address
First Line	:	850 OLIVE ST
Second Line	:	STE A
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2162
Country	:	US
Telephone Number	:	318-222-3662
Fax Number	:	318-222-0034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/12/2025

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