Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | ME80894 | FL |
NPI | 1548234388 |
---|---|
Provider Name | Dr. Lawrence Holder |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 03/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D77878 | (02) | FL |