Individual
LARRY W HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
751 N RUTLEDGE ST, STE 1100, SPRINGFIELD, IL 62702-4968
(217) 545-0182
(217) 545-4735
Mailing address
PO BOX 19636, SPRINGFIELD, IL 62794-9636
(217) 545-0182
(217) 545-4735
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036076848
IL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
036076848
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076848
—
IL
Enumeration date
04/26/2006
Last updated
04/12/2013
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