Provider Demographics
NPI:1225134018
Name:HOLLAND, RODNEY R (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:R
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 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:3702 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3624
Practice Address - Country:US
Practice Address - Phone:970-207-9773
Practice Address - Fax:970-207-1893
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3470A207RG0100X
CO33451207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334515Medicaid
CO100006588OtherMEDICARE RAILROAD
CO100006588OtherMEDICARE RAILROAD
CO100006588OtherMEDICARE RAILROAD
WYW302209Medicare PIN
CO01334515Medicaid