Provider Demographics
NPI:1619225885
Name:HOLDER, BARRETT KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:KENT
Last Name:HOLDER
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 1:1055 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:BLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65014-3091
Mailing Address - Country:US
Mailing Address - Phone:573-943-2146
Mailing Address - Fax:
Practice Address - Street 1:1055 HIGHWAY D
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:MO
Practice Address - Zip Code:65014-3091
Practice Address - Country:US
Practice Address - Phone:573-943-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist