Provider Demographics
NPI:1255301644
Name:HOLBROOK, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:HOLBROOK
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 1:3 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6529
Mailing Address - Country:US
Mailing Address - Phone:423-434-6300
Mailing Address - Fax:423-434-6312
Practice Address - Street 1:3 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 21
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6529
Practice Address - Country:US
Practice Address - Phone:423-434-6300
Practice Address - Fax:423-434-6312
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18713207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903976Medicaid
TN3043199Medicaid
TNE04251Medicare UPIN
TN3043199Medicaid
TN3043199Medicare PIN