Provider Demographics
NPI:1356492342
Name:HOLSTON, ROBERT G (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:HOLSTON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:ROBERT HOLSTON DO 7804 HWY 25 E
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049
Mailing Address - Country:US
Mailing Address - Phone:615-654-4111
Mailing Address - Fax:615-654-2867
Practice Address - Street 1:ROBERT HOLSTON DO
Practice Address - Street 2:7804 HWY 25 E
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049
Practice Address - Country:US
Practice Address - Phone:615-654-4111
Practice Address - Fax:615-654-2867
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDO208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND97404Medicare UPIN
TN3302383Medicare ID - Type Unspecified