Basic Information
| Provider Information | |||||||||
| NPI: | 1982196044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERIC EDWARD HOLT, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52244 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711352244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187984539 | ||||||||
| FaxNumber: | 3187984601 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186456161 | ||||||||
| FaxNumber: | 3186456168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOLT | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5046448030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD.015961 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1385069 | 05 | LA | MEDICAID |