Provider Demographics
NPI:1093060071
Name:JOHN P. HOLLAND, MD, PC
Entity Type:Organization
Organization Name:JOHN P. HOLLAND, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-200-5020
Mailing Address - Street 1:1420 MARVIN ROAD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516
Mailing Address - Country:US
Mailing Address - Phone:206-200-5020
Mailing Address - Fax:360-786-6016
Practice Address - Street 1:1420 MARVIN RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3878
Practice Address - Country:US
Practice Address - Phone:206-200-5020
Practice Address - Fax:360-786-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000211232083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty