Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036060340 | IL |
NPI | 1023081502 |
---|---|
Provider Name | William J. Holt |
First Address | Quincy, IL 62301-4038 |
Second Address | Quincy, IL 62301-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036060340 | (05) | IL |
D14333 | (02) |