Provider Demographics
NPI:1164841201
Name:HOLLAND, BENJAMIN DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FISHER STREET
Mailing Address - Street 2:KEESLER MC EMERGENCY DEPT
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:228-376-0500
Mailing Address - Fax:
Practice Address - Street 1:500 FISHER STREET
Practice Address - Street 2:KEESLER MC EMERGENCY DEPT
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS25059207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty