Provider Demographics
NPI:1356381891
Name:HOLLAND, GERRY P (DO)
Entity type:Individual
Prefix:
First Name:GERRY
Middle Name:P
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DO
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 803
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-0803
Mailing Address - Country:US
Mailing Address - Phone:806-355-9595
Mailing Address - Fax:806-353-1589
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-4200
Practice Address - Fax:405-272-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126939101Medicaid
TX126939105Medicaid
OK200243700AMedicaid
OKOK700671Medicare PIN
OK200243700AMedicaid
TX126939105Medicaid