Provider Demographics
NPI:1134177736
Name:HOLM, LLOYD D (DO)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:D
Last Name:HOLM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E POLK ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1237
Mailing Address - Country:US
Mailing Address - Phone:319-653-2229
Mailing Address - Fax:319-653-5040
Practice Address - Street 1:418 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-2229
Practice Address - Fax:319-653-5040
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134177736Medicaid
IA1134177736Medicare Oscar/Certification