Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 26384 | WI |
NPI | 1023110939 |
---|---|
Provider Name | James J Holt |
First Address | Marshfield, WI 54449-5777 |
Second Address | Marshfield, WI 54449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30617100 | (05) | WI |
B53675 | (02) |