Individual
DAVID GLENN HOLST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
824 PINE ST, MOUNT SHASTA, CA 96067-2137
(530) 926-4528
(530) 926-5070
Mailing address
PO BOX 339, MOUNT SHASTA, CA 96067-0339
(530) 926-5613
(530) 926-8798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G76027
CA
207VX0000X
Obstetrics Physician
G76027
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G760270
—
CA
01
—
080080840
RAILROAD MEDICARE
—
Enumeration date
09/09/2005
Last updated
09/19/2013
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