Provider Demographics
NPI:1588648075
Name:HOLDER, ROBERT FRED (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRED
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:F
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2106 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8408
Mailing Address - Country:US
Mailing Address - Phone:956-423-9111
Mailing Address - Fax:956-423-9273
Practice Address - Street 1:2106 HALE AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8408
Practice Address - Country:US
Practice Address - Phone:956-423-9111
Practice Address - Fax:956-423-9273
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038GVOtherBLUE CROSS/BLUE SHIELD
TX129756100OtherVALLEY HEALTH PLANS
TX143421901Medicaid
TX00156QMedicare PIN
TX143421901Medicaid