Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1491 | CO |
NPI | 1740202563 |
---|---|
Provider Name | Dr. Freeman J. Holland JR. |
First Address | Wheat Ridge, CO 80033-5055 |
Second Address | Wheat Ridge, CO 80033-5055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 01/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08149106 | (05) | CO |
T60482 | (02) | CO |