Provider Demographics
NPI:1528257003
Name:HOLLIS, ROLAND (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 HIGHWAY 49 N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4007
Mailing Address - Country:US
Mailing Address - Phone:870-236-1014
Mailing Address - Fax:870-236-9669
Practice Address - Street 1:400 HIGHWAY 49 N
Practice Address - Street 2:SUITE 2
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4007
Practice Address - Country:US
Practice Address - Phone:870-236-1014
Practice Address - Fax:870-236-9669
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC7703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117653001Medicaid
AR53370Medicare PIN
AR5H413Medicare PIN
ARE19142Medicare UPIN