MEDICARE: TERRY DON HOLT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME72495	FL
2	207Q00000X	Family Medicine Physician	44957	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29507	OTHER	FL	BLUE CROSS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639152234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY DON HOLT MD

Provider Business Mailing Address
First Line	:	PO BOX 111
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-0111
Country	:	US
Telephone Number	:	270-757-0014
Fax Number	:	270-757-0015

Provider Business Practice Location Address
First Line	:	101 LEGION DR
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-1496
Country	:	US
Telephone Number	:	270-757-0014
Fax Number	:	270-757-0015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	03/09/2015

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