Basic Information
| Provider Information | |||||||||
| NPI: | 1669513800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLIS | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | FLOYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244451 | ||||||||
| FaxNumber: | 9704904199 | ||||||||
| Practice Location | |||||||||
| Address1: | 5818 N NEVADA AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809183505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193651950 | ||||||||
| FaxNumber: | 7193640022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 52078 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 52078 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 204032601 | 05 | MO | MEDICAID | 90939069 | 05 | CO | MEDICAID |