Doctor Name: | DR. EWELL MAYDELL HOLLIS |
NPI Number: | 1003953555 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101230465 |
Business Practice Address: | 22d Meu Ce Medical Dept Psc Box 20082 Camp Lejeune, NC - 285420082 |
Business Phone Number: | 9104510703 |
Business Fax Number: | |
Mailing Address: | Po Box 9086, CAMP LEJEUNE |
State: | NC |
Postal Code: | 285479086 |
Phone Number: | 9104510703 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101230465 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |