Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | WV20262 | WV |
NPI | 1003803891 |
---|---|
Provider Name | Dr. Cecil Todd Holbert |
First Address | Philippi, WV 26416 |
Second Address | Philippi, WV 26416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 29/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003803891 | (05) | WV |
H51968 | (02) | WV |
P00276759 | RAILROAD MEDICARE (01) | WV |