Organization
NEUROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM A HOLT D.O. (PRESIDENT)
(941) 764-0800
Entity
Organization
Contact information
Practice address
4161 TAMIAMI TRL, SUITE 201, PORT CHARLOTTE, FL 33952-9208
(941) 764-0800
(941) 764-6494
Mailing address
4161 TAMIAMI TRL, SUITE 201, PORT CHARLOTTE, FL 33952-9208
(941) 764-0800
(941) 764-6494
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME85919
FL
174400000X
Specialist
ME99150
FL
174400000X
Specialist
Primary
OS5338
FL
363AM0700X
Medical Physician Assistant
PA9101267
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262779500
—
FL
01
—
CK2663
RAILROAD MEDICARE
FL
Enumeration date
06/25/2006
Last updated
02/22/2008
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