Provider Demographics
NPI:1558472530
Name:HOLT, JONATHAN D (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
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 1:969 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6676
Mailing Address - Country:US
Mailing Address - Phone:940-391-3035
Mailing Address - Fax:
Practice Address - Street 1:8301 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9320
Practice Address - Country:US
Practice Address - Phone:469-246-6300
Practice Address - Fax:469-246-6308
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2981207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00650231OtherRAILROAD
TX186862201Medicaid
TX8AC200OtherBCBS
TXP00650231OtherRAILROAD