Doctor Name: | DAVID GLENN HOLST |
NPI Number: | 1164416764 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G76027 |
Business Practice Address: | 824 Pine St Mount Shasta, CA - 960672137 |
Business Phone Number: | 5309264528 |
Business Fax Number: | 5309265070 |
Mailing Address: | Po Box 339, MOUNT SHASTA |
State: | CA |
Postal Code: | 960670339 |
Phone Number: | 5309265613 |
Fax Number: | 5309268798 |
NPI Enumeration Date: | 09/09/2005 |
NPI Last Update Date: | 09/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VX0000X |
License Number: | G76027 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Obstetrics |
Taxonomy Definition: |