Provider Demographics
NPI:1881601615
Name:HOLST, GREGORY S (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:HOLST
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 1:2675 HARRIS STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503
Mailing Address - Country:US
Mailing Address - Phone:707-443-8335
Mailing Address - Fax:707-443-7327
Practice Address - Street 1:2675 HARRIS STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-443-8335
Practice Address - Fax:707-443-7327
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH0615462OtherBCBS PROV #
CO080182153OtherRR MCR PROV #
CO84601413802OtherPACIFICARE PROV #
NE84601413812Medicaid
CO01355239Medicaid
CO846014138009OtherROCKY MTN HMO PROV #
CO846014138009OtherROCKY MTN HMO PROV #
COG40380Medicare UPIN
CA439078Medicare UPIN