Basic Information
| Provider Information | |||||||||
| NPI: | 1194136556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLTON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALLAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1848 | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494431848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316727800 | ||||||||
| FaxNumber: | 2316727801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 LEAHY ST STE 201A | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316727800 | ||||||||
| FaxNumber: | 2316727801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301116240 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | BP10049459 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.