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NPI Code Detail

MEDICARE: DR. HOLLY R RECOB DO

MEDICARE:  DR. HOLLY R RECOB  DO
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
1207Q00000XFamily Medicine Physician34005413ROH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
137347OTHEROHBCBS
24324562OTHEROHAETNA

General Provider Information

NPI Number : 1659466720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOLLY R RECOB DO
Provider Business Mailing Address
First Line : PO BOX 367
Second Line : 460 S MAIN ST
City : MOUNT VICTORY
State : OH
Zip : 43340-0367
Country : US
Telephone Number : 937-354-2027
Fax Number : 937-354-2029
Provider Business Practice Location Address
First Line : 460 S MAIN ST
Second Line :
City : MOUNT VICTORY
State : OH
Zip : 43340-8869
Country : US
Telephone Number : 937-354-2027
Fax Number : 937-354-2029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 01/25/2022

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Directions to “ DR. HOLLY R RECOB DO” Practice Location

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