Provider Demographics
NPI:1780657601
Name:HOLLAND, MARTIN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:CARLOS
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:1717 13TH ST STE 401
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-297-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG067903207T00000X
TXN6359207T00000X
WAMD60550761207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V3854OtherBCBS
TX752616977095OtherTRICARE
CAGV008ZOtherMEDICARE PTAN
CAGV008YOtherMEDICARE PTAN
TX212967801Medicaid
TX212967801Medicaid
TXTXB102481Medicare Oscar/Certification