Provider Demographics
NPI:1194009357
Name:EDWARD LEE HOLT, DO, P.A.
Entity Type:Organization
Organization Name:EDWARD LEE HOLT, DO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-937-1588
Mailing Address - Street 1:1795 N. HIGHWAY 77
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7812
Mailing Address - Country:US
Mailing Address - Phone:972-937-1588
Mailing Address - Fax:972-937-1274
Practice Address - Street 1:1795 N. HIGHWAY 77
Practice Address - Street 2:SUITE 103
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7812
Practice Address - Country:US
Practice Address - Phone:972-937-1588
Practice Address - Fax:972-937-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8248207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty