1962457077 NPI number — GARY E HOLLAND MD

Table of content: GARY E HOLLAND MD (NPI 1962457077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962457077 NPI number — GARY E HOLLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
GARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962457077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 FAIRWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35057-6982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-727-9067
Provider Business Mailing Address Fax Number:
256-727-9076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18741 US HIGHWAY 31 STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35058-0259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-727-9067
Provider Business Practice Location Address Fax Number:
256-727-9076
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  15456 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000087049 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051512576 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051512576 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051512576 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110246699 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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