Healthcare Provider Details

I. General information

NPI: 1235126434
Provider Name (Legal Business Name): ALBERT EDWARD HOLT IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 LANE AVE S
JACKSONVILLE FL
32205-4706
US

IV. Provider business mailing address

358 PLAZA
ATLANTIC BEACH FL
32233-5442
US

V. Phone/Fax

Practice location:
  • Phone: 888-831-2949
  • Fax: 833-973-6210
Mailing address:
  • Phone: 888-831-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME148102
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD00612264
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number159488
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number159488
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0061264
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: