Provider Demographics
NPI:1902101215
Name:HOLBROOK, TOMMY LANE II (DO)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:LANE
Last Name:HOLBROOK
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BECKLEY CROSSING SHPG CTR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7110
Mailing Address - Country:US
Mailing Address - Phone:304-252-6639
Mailing Address - Fax:
Practice Address - Street 1:520 BECKLEY CROSSING SHPG CTR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7110
Practice Address - Country:US
Practice Address - Phone:304-252-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine