Provider Demographics
NPI:1659199388
Name:B SHANE HOLLAND, DO, PLLC
Entity type:Organization
Organization Name:B SHANE HOLLAND, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-389-2803
Mailing Address - Street 1:4310 W WOODVIEW
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8084
Mailing Address - Country:US
Mailing Address - Phone:405-714-1733
Mailing Address - Fax:
Practice Address - Street 1:5208 W VILLAGE PKWY STE 1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8199
Practice Address - Country:US
Practice Address - Phone:479-389-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center