Provider Demographics
NPI:1982629283
Name:HOLDER, DOUGLAS AARON (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:AARON
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0100
Mailing Address - Country:US
Mailing Address - Phone:903-785-6029
Mailing Address - Fax:903-785-5421
Practice Address - Street 1:3015 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-785-5500
Practice Address - Fax:903-784-0970
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK64702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
044851605OtherAMERIGROUP
044851604OtherAMERIGROUP
TX044851604Medicaid
TX044851605Medicaid
OK200042160AMedicaid
044851606OtherAMERIGROUP
TX044851606Medicaid
044851607OtherAMERIGROUP
TX044851607Medicaid
TX044851608Medicaid
AR159329001Medicaid
LA1777609Medicaid
TX044851606Medicaid
TX044851604Medicaid
H10454Medicare UPIN
TX8C9075Medicare ID - Type Unspecified
P00208257Medicare ID - Type UnspecifiedRAILROAD
TX8C9074Medicare ID - Type Unspecified
AR159329001Medicaid
LA1777609Medicaid