Healthcare Provider Details

I. General information

NPI: 1780780189
Provider Name (Legal Business Name): GARY F HOLLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 FRONTIER DR
MORGAN UT
84050-9734
US

IV. Provider business mailing address

5226 FRONTIER DR SUITE C
MORGAN UT
84050-9734
US

V. Phone/Fax

Practice location:
  • Phone: 801-368-0671
  • Fax:
Mailing address:
  • Phone: 801-876-3749
  • Fax: 801-876-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3088050-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: