Provider Demographics
NPI:1912009861
Name:HOLMAN, JASON GRANT (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:GRANT
Last Name:HOLMAN
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:UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-0001
Mailing Address - Country:US
Mailing Address - Phone:573-882-2100
Mailing Address - Fax:573-884-6109
Practice Address - Street 1:UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-5822
Practice Address - Country:US
Practice Address - Phone:573-882-2100
Practice Address - Fax:573-884-6109
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0102207P00000X, 207R00000X
MOT2004016534208000000X
MO2020019644207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTIN PLUS SUFFIX 001OtherTRICARE
TX195606204Medicaid
TX75-0818167-048OtherTRICARE
TX8CS941OtherBCBS
TXTIN PLUS 028OtherTRICARE
TX195606202Medicaid
TX195606203Medicaid
TX75-0818167-015OtherTRICARE
TX750818167044OtherTRICARE MFH WINNSBORO
TX8CM273OtherBCBS MFH WINNSBORO LOCATION
TXTIN PLUS 002OtherTRICARE TC LAKE PALESTINE
TX751976930005OtherTRICARE MFH JACKSONVILLE
TX8BC073OtherBCBS
TX8CM740OtherBCBS MFH JACKSONVILLE LOCATION
TXTIN PLUS 022OtherTRICARE TYLER DIRECT CARE LOCATION
TX195606201Medicaid
TX750818167044OtherTRICARE MFH WINNSBORO
TX75-0818167-048OtherTRICARE
TXTIN PLUS 002OtherTRICARE TC LAKE PALESTINE
TX8CS941OtherBCBS
TX195606201Medicaid
TX195606204Medicaid
TX8L0701Medicare Oscar/Certification