Basic Information
| Provider Information | |||||||||
| NPI: | 1881702678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LESLIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 22ND STREET | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033387595 | ||||||||
| FaxNumber: | 5033254905 | ||||||||
| Practice Location | |||||||||
| Address1: | 2265 EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033387595 | ||||||||
| FaxNumber: | 5033254905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/23/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD23855 | OR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD000025542 | WA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 286588 | 05 | OR | MEDICAID |