Provider Demographics
NPI:1659350270
Name:HOLT, RICHARD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:HOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5907
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-615-7170
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-615-7170
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4133207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034443401Medicaid
TX8Z1700OtherBCBS
TX8Z1700OtherBCBS
TX034443401Medicaid