Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14322 | NV |
N | 207X00000X | Orthopaedic Surgeon | A121113 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 56331 | MN |
NPI | 1184832578 |
---|---|
Provider Name | Jason Scott Holm |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Burnsville, MN 55337-4480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 19/09/2013 |