Provider Demographics
NPI:1316997703
Name:HOLLAND, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
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 8549
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0549
Mailing Address - Country:US
Mailing Address - Phone:817-451-4208
Mailing Address - Fax:817-563-3699
Practice Address - Street 1:4780 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2913
Practice Address - Country:US
Practice Address - Phone:214-469-2500
Practice Address - Fax:214-469-1111
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0113207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174656208Medicaid
TX8P0438OtherBLUE CROSS BLUE SHIELD
TX0092NKOtherBCBS
TX174656205Medicaid
TXP00338344Medicare PIN
TX612547Medicare PIN
TX174656208Medicaid
I31685Medicare UPIN