Healthcare Provider Details

I. General information

NPI: 1225134018
Provider Name (Legal Business Name): RODNEY R HOLLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 S TIMBERLINE RD
FORT COLLINS CO
80525-3624
US

IV. Provider business mailing address

3702 S TIMBERLINE RD
FORT COLLINS CO
80525-3624
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-9773
  • Fax: 970-207-1893
Mailing address:
  • Phone: 970-207-9773
  • Fax: 970-207-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3470A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number33451
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: