Individual
DR. JOHN ROBERT HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
15567
TX
207L00000X
Anesthesiology Physician
15567
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0902165
—
TX
01
—
75-2277547
FEDERAL TAX ID
TX
01
—
K53H
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/21/2005
Last updated
11/19/2013
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