Provider Demographics
NPI:1902895725
Name:HOLLAND, GARY MAX (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MAX
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-794-5425
Mailing Address - Fax:325-794-5426
Practice Address - Street 1:6399 DIRECTORS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-794-5425
Practice Address - Fax:325-794-5426
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11523004Medicaid
TX838066Medicare PIN
TX838066Medicare ID - Type Unspecified
TX11523004Medicaid