Healthcare Provider Details

I. General information

NPI: 1255886990
Provider Name (Legal Business Name): NATHAN B HOLLADAY MD PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 E 4800 S STE 160
MURRAY UT
84107-5507
US

IV. Provider business mailing address

865 E 4800 S STE 160
MURRAY UT
84107-5507
US

V. Phone/Fax

Practice location:
  • Phone: 385-251-6028
  • Fax:
Mailing address:
  • Phone: 385-251-6028
  • Fax: 801-262-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN BRENT HOLLADAY
Title or Position: MEMBER
Credential: MD, PHD
Phone: 385-251-6028