Provider Demographics
NPI:1639152234
Name:HOLT, TERRY DON (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DON
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:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-0111
Mailing Address - Country:US
Mailing Address - Phone:270-757-0014
Mailing Address - Fax:270-757-0015
Practice Address - Street 1:101 LEGION DR
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1496
Practice Address - Country:US
Practice Address - Phone:270-757-0014
Practice Address - Fax:270-757-0015
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72495207Q00000X
KY44957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29507OtherBLUE CROSS PROVIDER #
KY7100209090Medicaid
FLE16273Medicare UPIN
KY7100209090Medicaid
KYK058112Medicare PIN