Healthcare Provider Details

I. General information

NPI: 1952491037
Provider Name (Legal Business Name): AARON JEFFREY HOLM RT-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ADAMS STREET UNIT T
CORDOVA AK
99574
US

IV. Provider business mailing address

600 ADAMS STREET UNIT T
CORDOVA AK
99574
US

V. Phone/Fax

Practice location:
  • Phone: 907-424-5959
  • Fax:
Mailing address:
  • Phone: 907-424-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: