Healthcare Provider Details

I. General information

NPI: 1780896191
Provider Name (Legal Business Name): DOUGLAS BRIAN HOLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 5TH AVE
SPOKANE WA
99204-4820
US

IV. Provider business mailing address

10737 LAUREL ST SUITE #230
RANCHO CUCAMONGA CA
91730-3837
US

V. Phone/Fax

Practice location:
  • Phone: 509-992-1888
  • Fax: 509-293-6508
Mailing address:
  • Phone: 909-989-5556
  • Fax: 909-989-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61091596
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: