Provider Demographics
NPI: | 1942680830 |
---|---|
Name: | HOLT, DAVID W (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DAVID |
Middle Name: | W |
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: | 801 S STEVENS ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SPOKANE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99204-2654 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-747-4455 |
Mailing Address - Fax: | 509-363-7064 |
Practice Address - Street 1: | 801 S STEVENS ST |
Practice Address - Street 2: | |
Practice Address - City: | SPOKANE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99204-2654 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-747-4455 |
Practice Address - Fax: | 509-363-7064 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2015-06-04 |
Last Update Date: | 2023-11-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD61127468 | 2085R0204X, 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 1942680830 | Other | NPI |