Provider Demographics
NPI:1114087293
Name:HOLLAND, WILLIAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 N 51ST AVE
Mailing Address - Street 2:STE. 203B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1721
Mailing Address - Country:US
Mailing Address - Phone:623-846-5407
Mailing Address - Fax:623-845-0890
Practice Address - Street 1:4616 N 51ST AVE
Practice Address - Street 2:STE. 203B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1721
Practice Address - Country:US
Practice Address - Phone:623-846-5407
Practice Address - Fax:623-845-0890
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ213637Medicaid
AZZWMBNK01Medicare PIN
AZ213637Medicaid