Provider Demographics
NPI:1780780189
Name:HOLLAND, GARY F (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
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 1:5226 FRONTIER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9734
Mailing Address - Country:US
Mailing Address - Phone:801-876-3749
Mailing Address - Fax:801-876-3697
Practice Address - Street 1:5226 FRONTIER DR
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9734
Practice Address - Country:US
Practice Address - Phone:801-368-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3088050-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000069025OtherMEDICARE GROUP
UT000069025OtherMEDICARE GROUP
UT006902501Medicare Oscar/Certification
UTU000077890Medicare PIN
UT1780780189Medicare UPIN
UTU000091530Medicare PIN
UT000067301Medicare PIN
UTU000091531Medicare PIN
UTU000074748Medicare PIN
UT1912136862Medicare UPIN
UT1598861999Medicare UPIN
UTD00636Medicare UPIN
UTU000077804Medicare PIN