Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | F2713 | TX |
Y | 207YS0123X | Facial Plastic Surgeon | F2713 | TX |
NPI | 1679680730 |
---|---|
Provider Name | G. Richard Holt |
First Address | San Antonio, TX 78229-3931 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120236808 | (05) | TX |
120236809 | CSHCN (01) | TX |