Provider Demographics
NPI:1669455630
Name:HOLT, RICHARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
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 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-585-2300
Mailing Address - Fax:502-584-2726
Practice Address - Street 1:250 E LIBERTY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1530
Practice Address - Country:US
Practice Address - Phone:502-585-2300
Practice Address - Fax:502-584-2726
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20867207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50040686OtherPASSPORT (JPG)
IN100333520AMedicaid
KY64208671Medicaid
KYP01087854-JPGRRMedicare PIN
KYK051410 (JPG)Medicare PIN
KY0239301Medicare PIN
C63376Medicare UPIN
IN228550002JPGMEDICAREMedicare PIN
KY50040686OtherPASSPORT (JPG)