Provider Demographics
NPI:1720283187
Name:HOLT, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 WOODLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2651
Mailing Address - Country:US
Mailing Address - Phone:270-765-5921
Mailing Address - Fax:270-765-4391
Practice Address - Street 1:1324 WOODLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2651
Practice Address - Country:US
Practice Address - Phone:270-765-5921
Practice Address - Fax:270-765-4391
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38970207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00460001Medicare PIN
KY0200207Medicare PIN
KY00502001Medicare PIN