Provider Demographics
NPI:1518596824
Name:OVERHOLT, LUC ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:LUC
Middle Name:ALLAN
Last Name:OVERHOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1020 JOHNSON ROAD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6002
Mailing Address - Country:US
Mailing Address - Phone:720-723-5027
Mailing Address - Fax:720-723-7928
Practice Address - Street 1:1020 JOHNSON ROAD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6002
Practice Address - Country:US
Practice Address - Phone:303-914-2680
Practice Address - Fax:720-723-7928
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0069579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine