Provider Demographics
NPI:1225097074
Name:HOLLAND, GARY G (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10875 PARK BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5456
Mailing Address - Country:US
Mailing Address - Phone:727-292-2247
Mailing Address - Fax:877-328-1192
Practice Address - Street 1:10875 PARK BLVD
Practice Address - Street 2:STE A
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5456
Practice Address - Country:US
Practice Address - Phone:727-292-2247
Practice Address - Fax:877-328-1192
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0018048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71639YMedicare UPIN
FL71639Medicare ID - Type Unspecified