Individual
DR. J. MICHAEL HOLBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-9253
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G1825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004905-02
—
TX
01
—
1004905-03
CSHCN
TX
05
—
1467412668
—
NC
01
—
300117258
RR/MEDICARE
TX
01
—
8A3362
BLUE SHIELD
TX
Enumeration date
03/23/2006
Last updated
08/12/2015
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