Provider Demographics
NPI:1447454368
Name:HOLLADAY, NATHAN BRENT (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BRENT
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 E 4800 S STE 160
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5507
Mailing Address - Country:US
Mailing Address - Phone:385-251-6028
Mailing Address - Fax:801-262-1844
Practice Address - Street 1:865 E 4800 S STE 160
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5507
Practice Address - Country:US
Practice Address - Phone:385-251-6028
Practice Address - Fax:801-262-1844
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9651064-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT175867OtherPEHP
UT100001392794OtherREGENCE BCBS (UT)
NCP00963705OtherRAILROAD MEDICARE
NC5916050Medicaid