Provider Demographics
NPI:1396785838
Name:GERRY P HOLLAND DO PA
Entity type:Organization
Organization Name:GERRY P HOLLAND DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-274-5131
Mailing Address - Street 1:100 SOUTH MCGEE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007
Mailing Address - Country:US
Mailing Address - Phone:806-274-5131
Mailing Address - Fax:806-274-5132
Practice Address - Street 1:100 SOUTH MCGEE
Practice Address - Street 2:SUITE 101
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007
Practice Address - Country:US
Practice Address - Phone:806-274-5131
Practice Address - Fax:806-274-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126939105Medicaid
TX458933Medicare Oscar/Certification