Provider Demographics
NPI:1043496300
Name:HOLT, BRIAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-262-7960
Mailing Address - Fax:505-232-1368
Practice Address - Street 1:715 MARTIN LUTHER KING AVE NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3661
Practice Address - Country:US
Practice Address - Phone:505-262-7281
Practice Address - Fax:505-262-7622
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2015-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0842208600000X
MO2010008617208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery