Provider Demographics
NPI:1700037041
Name:J ANTHONY HOLDER,MD,PLLC
Entity Type:Organization
Organization Name:J ANTHONY HOLDER,MD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-0234
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-926-0234
Mailing Address - Fax:270-926-0257
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-926-0234
Practice Address - Fax:270-926-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22716208D00000X
KYPA819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty