Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | TX8681 | TX |
NPI | 1841371135 |
---|---|
Provider Name | Dr. James Barry Holton |
First Address | Tyler, TX 75701-1937 |
Second Address | Tyler, TX 75701-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 05/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00L740 | BC/BS # (01) | TX |
130586402 | (05) | TX |
130586404 | (05) | TX |
130586406 | (05) | TX |
751572652 | TAX ID# (01) | TX |
T13894 | (02) | TX |