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General NPI Number Information
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NPI Number | 1366543902
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Entity Type | Individual
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Provider Name | GRADY MICHAEL HOLDER MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11005 RALSTON RD SUITE 100G
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City | ARVADA
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State | CO
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Zip | 80004-4551
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Country | US
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Telephone | 303-431-0844
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Fax | 303-456-6124
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Provider Business Mailing Address
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Address Line | 3701 S BROADWAY
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City | ENGLEWOOD
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State | CO
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Zip | 80113-3611
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Country | US
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Telephone | 303-360-6276
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Fax | 303-467-5355
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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 | DR.0028219
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License Number State | CO
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