Provider Demographics
NPI:1790909950
Name:HOLDER, JASON B (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
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 1:5800 W 10TH ST STE 610
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1761
Mailing Address - Country:US
Mailing Address - Phone:501-661-9393
Mailing Address - Fax:501-663-4795
Practice Address - Street 1:5800 WEST 10TH STREET
Practice Address - Street 2:SUITE 610
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1761
Practice Address - Country:US
Practice Address - Phone:150-166-9393
Practice Address - Fax:501-663-4795
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6594207RC0200X, 207RP1001X
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program