Provider Demographics
NPI:1235163353
Name:HOLLAND, JAY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DOUGLAS
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4601 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3860
Mailing Address - Country:US
Mailing Address - Phone:501-664-0769
Mailing Address - Fax:501-664-9558
Practice Address - Street 1:4601 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3860
Practice Address - Country:US
Practice Address - Phone:501-664-0769
Practice Address - Fax:501-664-9558
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1052200001Medicaid
AR0120797OtherUHC
D04651Medicare UPIN
52442Medicare ID - Type Unspecified