Healthcare Provider Details

I. General information

NPI: 1649201252
Provider Name (Legal Business Name): MARC L HOLBROOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S 3RD ST
DANVILLE KY
40422-1823
US

IV. Provider business mailing address

3490 VINCE RD
NICHOLASVILLE KY
40356-8830
US

V. Phone/Fax

Practice location:
  • Phone: 859-621-0763
  • Fax: 859-263-7441
Mailing address:
  • Phone: 859-621-0763
  • Fax: 859-263-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18602
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: