Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 15332 | MS |
NPI | 1063527356 |
---|---|
Provider Name | Dr. James Holland |
First Address | Gulfport, MS 39502-1810 |
Second Address | Gulfport, MS 39503-3063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 10/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00118024 | (05) | MS |
370009291 | RAILROAD MEDICARE (01) | MS |
G46494 | (02) | MS |