1598728891 NPI number — PETER DAVID HOLT MD

Table of content: PETER DAVID HOLT MD (NPI 1598728891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598728891 NPI number — PETER DAVID HOLT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLT
Provider First Name:
PETER
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598728891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11995 SINGLETREE LN
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-595-1301
Provider Business Mailing Address Fax Number:
612-294-4903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 QUEEN EMMA ST
Provider Second Line Business Practice Location Address:
APT 1511
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-595-1100
Provider Business Practice Location Address Fax Number:
612-294-4903
Provider Enumeration Date:
04/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  M9222 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD-16297 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 042-0010901 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111853400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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