Individual
DR. BRUCE ROBERT HOLLADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
29856
KY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
29856
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000249593
ANTHEM
KY
01
—
200045151
MEDICARE RAILROAD
KY
01
—
428850004
MEDICARE DME
KY
05
—
64298565
—
KY
01
—
90008962
MEDICAID DME
KY
Enumeration date
06/01/2005
Last updated
02/03/2016
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