Healthcare Provider Details

I. General information

NPI: 1922071232
Provider Name (Legal Business Name): JOSHUA D HOLLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/27/2023
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15396 N 83RD AVE STE F101
PEORIA AZ
85381
US

IV. Provider business mailing address

15396 N 83RD AVE STE F101
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:
Title or Position:
Credential:
Phone: