Individual
JASON GRANT HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00, COLUMBIA, MO 65212-5822
(573) 882-2100
(573) 884-6109
Mailing address
UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00, COLUMBIA, MO 65212-0001
(573) 882-2100
(573) 884-6109
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
N0102
TX
207R00000X
Internal Medicine Physician
N0102
TX
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
2020019644
MO
208000000X
Pediatrics Physician
T2004016534
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195606201
—
TX
05
—
195606202
—
TX
05
—
195606203
—
TX
05
—
195606204
—
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-0818167-048
TRICARE
TX
01
—
750818167044
TRICARE MFH WINNSBORO
TX
01
—
751976930005
TRICARE MFH JACKSONVILLE
TX
01
—
8BC073
BCBS
TX
01
—
8CM273
BCBS MFH WINNSBORO LOCATION
TX
01
—
8CM740
BCBS MFH JACKSONVILLE LOCATION
TX
01
—
8CS941
BCBS
TX
01
—
TIN PLUS 002
TRICARE TC LAKE PALESTINE
TX
01
—
TIN PLUS 022
TRICARE TYLER DIRECT CARE LOCATION
TX
01
—
TIN PLUS 028
TRICARE
TX
01
—
TIN PLUS SUFFIX 001
TRICARE
TX
Enumeration date
09/02/2006
Last updated
06/15/2021
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