Individual
JOHN BLAKE HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1240 W GRANADA BLVD FL 2, ORMOND BEACH, FL 32174-5915
(386) 672-9503
(386) 672-0386
Mailing address
1240 W GRANADA BLVD, ORMOND BEACH, FL 32174-5915
(386) 236-6854
(386) 263-2996
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
ME58979
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME58979
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007WM
BLUE SHIELD FLORIDA
FL
05
—
012903200-GROUP
—
FL
05
—
371580900-INDIVIDUAL
—
FL
01
—
DV0492-GROUP
RR MEDICARE
FL
01
—
P01369815-INDIVIDUAL
RR MEDICARE
FL
Enumeration date
09/21/2005
Last updated
01/21/2025
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