Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35057302 | OH |
N | 208600000X | Surgeon | 35057302 | OH |
N | 208200000X | Surgeon | 35057302 | OH |
N | 208600000X | Surgeon | 35057302 | OH |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35057302 | OH |
NPI | 1316991268 |
---|---|
Provider Name | Greg C. Holland |
First Address | Columbus, OH 43213-5131 |
Second Address | Columbus, OH 43213-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000120306 | ATHEM (01) | OH |
0728734 | (05) | OH |
240003964 | MEDICARE RAILROAD (01) | OH |
4412279 | AETNA (01) | OH |
F15633 | (02) | OH |