Provider Demographics
NPI:1336700830
Name:HOLDER, CALEB
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:5950 UNIVERSITY AVE STE 220
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8231
Practice Address - Country:US
Practice Address - Phone:515-875-9410
Practice Address - Fax:515-875-9412
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-10060207Q00000X
IADO-06358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine