Provider Demographics
NPI:1235551680
Name:HOLBROOK, JAMES KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:HOLBROOK
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 1:130 KATE IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749-9071
Mailing Address - Country:US
Mailing Address - Phone:606-672-2341
Mailing Address - Fax:606-743-1655
Practice Address - Street 1:130 KATE IRELAND DR
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-9071
Practice Address - Country:US
Practice Address - Phone:606-672-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-19
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59453Medicare UPIN