Provider Demographics
NPI:1962457077
Name:HOLLAND, GARY E (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:213 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-6982
Mailing Address - Country:US
Mailing Address - Phone:256-727-9067
Mailing Address - Fax:256-727-9076
Practice Address - Street 1:18741 US HIGHWAY 31 STE 103
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0259
Practice Address - Country:US
Practice Address - Phone:256-727-9067
Practice Address - Fax:256-727-9076
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL15456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000087049Medicaid
AL051512576OtherBLUE CROSS BLUE SHIELD AL
AL051512576OtherBLUE CROSS BLUE SHIELD OF
AL051512576Medicaid
AL110246699OtherRAILROAD MEDICARE