Healthcare Provider Details

I. General information

NPI: 1700037041
Provider Name (Legal Business Name): J ANTHONY HOLDER,MD,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 FREDERICA ST SUITE 104
OWENSBORO KY
42301-3050
US

IV. Provider business mailing address

920 FREDERICA ST SUITE 104
OWENSBORO KY
42301-3050
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-0234
  • Fax: 270-926-0257
Mailing address:
  • Phone: 270-926-0234
  • Fax: 270-926-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22716
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA819
License Number StateKY

VIII. Authorized Official

Name: MR. JAMES ANTHONY HOLDER
Title or Position: OWNER
Credential: M.D.
Phone: 270-926-0234