Provider Demographics
NPI:1992860977
Name:HOLT, CHRISTOPHER GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GARY
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4520 EXECUTIVE DR
Mailing Address - Street 2:105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3018
Mailing Address - Country:US
Mailing Address - Phone:858-450-5900
Mailing Address - Fax:858-450-5903
Practice Address - Street 1:3940 4TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3193
Practice Address - Country:US
Practice Address - Phone:619-516-8931
Practice Address - Fax:619-516-8936
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA 96213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96213OtherMEDICAL LICENSE