Provider Demographics
NPI:1346241528
Name:HOLT, MARK WALKER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WALKER
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:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8429
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:214-222-2435
Practice Address - Street 1:760 N DENTON TAP RD
Practice Address - Street 2:SUITE 130
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2163
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:214-222-2435
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81M641OtherBCBS
TX128828406Medicaid
TX128828406Medicaid