Provider Demographics
NPI:1205864238
Name:HOLDER, LARRY BENSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BENSON
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 MEDICAL PARK LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6673
Mailing Address - Country:US
Mailing Address - Phone:828-837-1332
Mailing Address - Fax:828-837-0681
Practice Address - Street 1:75 MEDICAL PARK LN
Practice Address - Street 2:SUITE D
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6663
Practice Address - Country:US
Practice Address - Phone:828-837-1332
Practice Address - Fax:828-837-0681
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28214207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943041Medicaid
NC8943041Medicaid
NC3817687Medicare PIN