Healthcare Provider Details

I. General information

NPI: 1164841201
Provider Name (Legal Business Name): BENJAMIN DANIEL HOLLAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9812
  • Fax:
Mailing address:
  • Phone: 417-269-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2024047768
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25059
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: