MEDICARE: JOHN R HOLLAND D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	1948	TN
2	207P00000X	Emergency Medicine Physician	200400681	NC
3	207P00000X	Emergency Medicine Physician	DO172963	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679675854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R HOLLAND D.O.

Provider Business Mailing Address
First Line	:	3043 NE 28TH STREET
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-9540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3043 NE 28TH STREET
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-9540
Country	:	US
Telephone Number	:	541-996-7118
Fax Number	:	541-996-7378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/14/2023

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