Provider Demographics
NPI:1881614964
Name:HOLT, EDWARD LEE (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:HOLT
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 1:1795 N HIGHWAY 77 STE 103
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7876
Mailing Address - Country:US
Mailing Address - Phone:972-937-1588
Mailing Address - Fax:972-937-1274
Practice Address - Street 1:1795 N HIGHWAY 77 STE 103
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7876
Practice Address - Country:US
Practice Address - Phone:972-937-1588
Practice Address - Fax:972-937-1274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8248207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169073701Medicaid
TX8C6044Medicare ID - Type Unspecified
TX169073701Medicaid