Provider Demographics
NPI:1013070424
Name:HOLT, ERIC EDWARD I (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EDWARD
Last Name:HOLT
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7166 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7432
Mailing Address - Country:US
Mailing Address - Phone:210-614-0879
Mailing Address - Fax:210-614-7103
Practice Address - Street 1:4747 EARHART BLVD STE. J
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1743
Practice Address - Country:US
Practice Address - Phone:504-592-9818
Practice Address - Fax:504-522-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA015961207RN0300X
GA059081207RN0300X
246ZN0300X
LA59081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385069Medicaid
LA329679Medicare PIN
GAC33148Medicare UPIN