Provider Demographics
NPI:1780896191
Name:HOLL, DOUGLAS BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:HOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10737 LAUREL ST
Mailing Address - Street 2:SUITE #230
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3837
Mailing Address - Country:US
Mailing Address - Phone:909-989-5556
Mailing Address - Fax:909-989-5558
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4820
Practice Address - Country:US
Practice Address - Phone:509-992-1888
Practice Address - Fax:509-293-6508
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD610915962084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program