Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 7135 | NE |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN25920 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7135 | NE |
Y | 204E00000X | Oral & Maxillofacial Surgeon | ME144719 | FL |
NPI | 1154760411 |
---|---|
Provider Name | Dr. Tyler J Holley |
First Address | Gainesville, FL 32610-0416 |
Second Address | Gainesville, FL 32610-0416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 19/07/2021 |