Individual
MR. DOUGLAS S HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST
Contact information
Practice address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 846-4716
(309) 454-7348
Mailing address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 846-4716
(309) 454-7348
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
237000196
IL
Other
Enumeration date
08/09/2019
Last updated
09/12/2019
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