Individual
DR. BRADLY SHANE HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5208 W VILLAGE PKWY STE 1, ROGERS, AR 72758-8199
(479) 389-2803
Mailing address
4310 W WOODVIEW, ROGERS, AR 72758-8084
(479) 586-0984
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1639
TN
207P00000X
Emergency Medicine Physician
E5111
AR
207Q00000X
Family Medicine Physician
Primary
E-5111
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3300823
—
TN
01
—
4119511
BCBS OF TN
TN
Enumeration date
06/29/2006
Last updated
07/31/2024
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