Provider Demographics
NPI:1386638849
Name:HOLLAND, WALTER BOWLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:BOWLIN
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3001 S CHIPLEY FORD RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8121
Mailing Address - Country:US
Mailing Address - Phone:704-876-0572
Mailing Address - Fax:
Practice Address - Street 1:646 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3423
Practice Address - Country:US
Practice Address - Phone:704-872-4108
Practice Address - Fax:704-873-6517
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20096066OtherSELECT HEALTH OF SC
SC772549OtherWELLCARE
NC8943094Medicaid
SC01151985OtherAMERIGROUP COMMUNITY CARE
NC4223147OtherAETNA
SCQ21046Medicaid
NC332189OtherWELLPATH
SCP00294329OtherRAILROAD MEDICARE
SCQ21046OtherMEDICAID
NC1221507OtherUNITED HEALTHCARE
NC43094OtherBCBSNC
SC81895OtherCHC CARES OF SC
SC20096066OtherSELECT HEALTH OF SC
NC332189OtherWELLPATH