Individual
DR. MICHAEL GORDON HOLDER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2195
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2195
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
56873
TN
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
17601
NV
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
24022
MS
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
35-085978
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04179262
—
MS
Enumeration date
07/17/2006
Last updated
03/22/2018
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