Active NPI
E Carlisle Holland, D.O.
- General Practice Physician
- Sebastopol, CA
National Provider Identifier
1376570077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 20A6298
- Practice address
- 496 S Main St
Sebastopol, CA 95472-4211 - Phone
- (707) 824-8764
- Fax
- (707) 824-8766
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 20A6298 | CA | Primary |
Addresses
Primary practice location
496 S Main St
Sebastopol, CA 95472-4211
Mailing address
496 S Main St
Sebastopol, CA 95472-4211
Phone (707) 824-8764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A6298 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305590400000",
"number": "1376570077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "496 S MAIN ST",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724211",
"telephone_number": "707-824-8764",
"fax_number": "707-824-8766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "496 S MAIN ST",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724211",
"telephone_number": "707-824-8764",
"fax_number": "707-824-8766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND",
"first_name": "E",
"middle_name": "CARLISLE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2011-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "20A6298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.