Healthcare Provider Details

I. General information

NPI: 1184672081
Provider Name (Legal Business Name): CLINTON FAY HOLLAND DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE #410
ENGLEWOOD CO
80113-3781
US

IV. Provider business mailing address

601 E HAMPDEN AVE #410
ENGLEWOOD CO
80113-3781
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-9255
  • Fax:
Mailing address:
  • Phone: 303-789-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number660
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number660
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number660
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number660
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number660
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: