Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 660 | CO |
Y | 222Z00000X | Podiatrist | 660 | CO |
N | 213EP0504X | Public Medicine | 660 | CO |
N | 213EP1101X | Primary Podiatric Medicine | 660 | CO |
N | 111NR0200X | Radiology | 660 | CO |
N | 213ER0200X | Radiology | 660 | CO |
N | 2081S0010X | Sports Medicine | 660 | CO |
N | 213ES0000X | Sports Medicine | 660 | CO |
N | 213ES0103X | Foot & Ankle Surgery | 660 | CO |
NPI | 1184672081 |
---|---|
Provider Name | Dr. Clinton Fay Holland |
First Address | Englewood, CO 80113-3781 |
Second Address | Englewood, CO 80113-3781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V09881 | (02) | CO |