Healthcare Provider Details

I. General information

NPI: 1174795785
Provider Name (Legal Business Name): HOLLAND CENTER FOR FAMILY MEDICINE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 W. THUNDERBIRD RD. SUITE E-100
PEORIA AZ
85381
US

IV. Provider business mailing address

6760 W. THUNDERBIRD RD. SUITE E-100
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-8477
  • Fax: 602-978-0734
Mailing address:
  • Phone: 602-978-8477
  • Fax: 602-978-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17551
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSHUA HOLLAND
Title or Position: OWNER
Credential: M.D.
Phone: 602-978-8477