Individual
DR. JOHN ROBERT HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2309 YORK AVE, LUBBOCK, TX 79407-2286
(806) 783-0520
(806) 783-0674
Mailing address
2309 YORK AVE, LUBBOCK, TX 79407-2286
(806) 783-0520
(806) 783-0674
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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