Provider Demographics
NPI:1366465650
Name:HOLDER, SARAH A (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:HOLDER
Suffix:
Gender:F
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 1666
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-1666
Mailing Address - Country:US
Mailing Address - Phone:407-323-9999
Mailing Address - Fax:407-320-9994
Practice Address - Street 1:200 S FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1166
Practice Address - Country:US
Practice Address - Phone:407-323-9999
Practice Address - Fax:407-320-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065339207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376207601Medicaid
FLD80808Medicare UPIN
FL376207601Medicaid