Provider Demographics
NPI:1942244330
Name:HOLT, WILLIAM TERRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TERRY
Last Name:HOLT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 SKYLINE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3903
Mailing Address - Country:US
Mailing Address - Phone:731-427-5581
Mailing Address - Fax:731-427-8257
Practice Address - Street 1:657 SKYLINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3903
Practice Address - Country:US
Practice Address - Phone:731-427-5581
Practice Address - Fax:731-427-8257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0004174OtherBLUE CROSS BLUE SHIELD
TN4596543OtherAETNA
TN3350858Medicaid
TN3350858Medicare ID - Type Unspecified
TN3350858Medicaid