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Individual

JACOB ERIC RONALD HOLT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
119 BOONE RIDGE DR, SUITE 201, JOHNSON CITY, TN 37615-4998
(423) 282-1480
(423) 928-1353
Mailing address
119 BOONE RIDGE DR, SUITE 201, JOHNSON CITY, TN 37615-4998
(423) 282-1480
(423) 928-1353

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42090
TN
207R00000X
Internal Medicine Physician
42866
CO
208M00000X
Hospitalist Physician
42090
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3000017
TN
05
73375039
CO
Enumeration date
08/21/2006
Last updated
05/08/2014
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