Provider Demographics
NPI:1598861999
Name:GARY F HOLLAND MD PC
Entity Type:Organization
Organization Name:GARY F HOLLAND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-876-3749
Mailing Address - Street 1:375 N MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1272
Mailing Address - Country:US
Mailing Address - Phone:801-876-3749
Mailing Address - Fax:801-876-3687
Practice Address - Street 1:375 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1272
Practice Address - Country:US
Practice Address - Phone:801-876-3749
Practice Address - Fax:801-876-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3088050-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT225046121003Medicaid
UT225046121003Medicaid
UT000057595Medicare ID - Type Unspecified