Provider Demographics
NPI:1306926274
Name:HOLLAND, JOANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HIDDEN SPRING LN
Mailing Address - Street 2:
Mailing Address - City:DRAIN
Mailing Address - State:OR
Mailing Address - Zip Code:97435-9754
Mailing Address - Country:US
Mailing Address - Phone:541-836-2371
Mailing Address - Fax:541-836-2374
Practice Address - Street 1:117 THIRD STREET
Practice Address - Street 2:
Practice Address - City:DRAIN
Practice Address - State:OR
Practice Address - Zip Code:97435
Practice Address - Country:US
Practice Address - Phone:541-836-2371
Practice Address - Fax:541-836-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269574Medicaid
ORD2223-01OtherPACIFICSOURCE
OR130075Medicare PIN
OR269574Medicaid
ORR130075Medicare PIN