Provider Demographics
NPI:1306848494
Name:HOLT, THOMAS DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:HOLT
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 1:875 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1234
Mailing Address - Country:US
Mailing Address - Phone:334-283-3111
Mailing Address - Fax:334-283-3656
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1234
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:334-283-3656
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009953445Medicaid
AL009953445Medicaid
AL51521553Medicare ID - Type Unspecified