Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 00234 | KY |
N | 222Z00000X | Podiatrist | 00234 | KY |
Y | 213E00000X | Podiatrist | 234 | KY |
Y | 222Z00000X | Podiatrist | 234 | KY |
N | 213ES0103X | Foot & Ankle Surgery | 234 | KY |
NPI | 1053303727 |
---|---|
Provider Name | Dr. Christopher Matthew Holland |
First Address | Bowling Green, KY 42104-3369 |
Second Address | Bowling Green, KY 42104-3369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 28/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000067936 | BCBS (01) | KY |
1115102 | PASSPORT (01) | KY |
1221960002 | PALMETTO GBA-DMERC (01) | KY |
480026332 | RAILROAD MEDICARE (01) | KY |
80002348 | (05) | KY |
90013897 | KYHEALTH CHOICES-DME (01) | KY |
U57692 | (02) |