Provider Demographics
NPI:1134117732
Name:HOLDS, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:HOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12990 MANCHESTER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1804
Mailing Address - Country:US
Mailing Address - Phone:314-567-3567
Mailing Address - Fax:314-567-6575
Practice Address - Street 1:12990 MANCHESTER RD
Practice Address - Street 2:STE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1804
Practice Address - Country:US
Practice Address - Phone:314-567-3567
Practice Address - Fax:314-567-6575
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N982086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D07409OtherMERCY HEALTH PLAN
42272OtherHEALTHCARE USA
IL06025871OtherBLUE CROSS BLUE SHIELD OF
0800205OtherUNITED HEALTHCARE
074803OtherHEALTH ALLIANCE
128620OtherHEALTHLINK
56190OtherOPTICARE
19098OtherBLUE CROSS BLUE SHIELD OF
0800205OtherUNITED HEALTHCARE
D07409Medicare UPIN