Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | M-8947 | ID |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD00021541 | WA |
NPI | 1114925161 |
---|---|
Provider Name | Dr. Donald Vernon Holbert |
First Address | Spokane, WA 99204-2349 |
Second Address | Spokane, WA 99204-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003236400 | (05) | ID |
11130991 | MEDICARE PTAN (01) | ID |
8617706 | (05) | WA |
A15625 | (02) | |
G8870917 | MEDICARE PTAN (01) | WA |
G8878499 | MEDICARE PTAN (01) | WA |