Provider Demographics
NPI:1902895725
Name:HOLLAND, GARY MAX (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MAX
Last Name:HOLLAND
Suffix:
Gender:M
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:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-794-5425
Mailing Address - Fax:325-794-5426
Practice Address - Street 1:850 N 6TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5242
Practice Address - Country:US
Practice Address - Phone:325-692-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9572251K00000X, 261QA0005X, 261QP0905X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No251K00000XAgenciesPublic Health or Welfare
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11523004Medicaid
TX11523004Medicaid
TX838066Medicare ID - Type Unspecified
TX11523004Medicaid