Provider Demographics
NPI:1417188780
Name:ALAN L HOLTON OB GYN, PLLC
Entity Type:Organization
Organization Name:ALAN L HOLTON OB GYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-7085
Mailing Address - Street 1:3909 SUNSET RIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6668
Mailing Address - Country:US
Mailing Address - Phone:919-787-7085
Mailing Address - Fax:919-787-7086
Practice Address - Street 1:3909 SUNSET RIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6668
Practice Address - Country:US
Practice Address - Phone:919-787-7085
Practice Address - Fax:919-787-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943885Medicaid
1316938798OtherINDIVIDUAL NPI