Provider Demographics
NPI:1740247873
Name:HOLT, PETER S (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:S
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 1:4321 WASHINGTON ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5928
Mailing Address - Country:US
Mailing Address - Phone:816-932-3100
Mailing Address - Fax:816-932-6871
Practice Address - Street 1:4321 WASHINGTON ST STE 3000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5928
Practice Address - Country:US
Practice Address - Phone:816-932-3100
Practice Address - Fax:816-932-6871
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22651207RG0300X
MOR9E05207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202650313Medicaid
MO0408094OtherUNITED HEALTH CARE
MO3204712003OtherCINGA
MO15160022OtherBLUE CROSS BLUE SHIELD
D 93577Medicare UPIN
MOP00077507Medicare ID - Type UnspecifiedRAILROAD
MOP870843Medicare ID - Type Unspecified
KSP880843Medicare ID - Type Unspecified