Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 14567 | NC |
NPI | 1023018173 |
---|---|
Provider Name | Windsor Austin Holt |
First Address | Raleigh, NC 27609-7341 |
Second Address | Raleigh, NC 27609-7341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8943455 | (05) | NC |
C84553 | (02) |