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General NPI Number Information
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NPI Number | 1164416764
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Entity Type | Individual
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Provider Name | DAVID GLENN HOLST MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 824 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2137
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Country | US
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Telephone | 530-926-4528
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Fax | 530-926-5070
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-0339
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Country | US
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Telephone | 530-926-5613
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Fax | 530-926-8798
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G76027
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | G76027
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License Number State | CA
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