Provider Demographics
NPI:1104822758
Name:HOLLANDER, JOHN DIRK (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DIRK
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MONTGOMERY DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6617
Mailing Address - Country:US
Mailing Address - Phone:707-578-1222
Mailing Address - Fax:707-578-8348
Practice Address - Street 1:95 MONTGOMERY DR STE 114
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6617
Practice Address - Country:US
Practice Address - Phone:707-578-1222
Practice Address - Fax:707-578-8348
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2845213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28450Medicaid
CA000E28450Medicaid
CAT11493Medicare UPIN
CA000E28450Medicare ID - Type Unspecified