Provider Demographics
NPI:1720156748
Name:HOLTY, JONERIK CLEOPHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONERIK
Middle Name:CLEOPHAS
Last Name:HOLTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JONERIK
Other - Middle Name:
Other - Last Name:HOLTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 PASTEUR DR # H3143
Mailing Address - Street 2:STANFORD UNIVERSITY SCHOOL OF MEDICINE
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-725-7061
Mailing Address - Fax:650-498-6288
Practice Address - Street 1:300 PASTEUR DR # H3143
Practice Address - Street 2:STANFORD UNIVERSITY SCHOOL OF MEDICINE
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-725-7061
Practice Address - Fax:650-498-6288
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72598207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease