Healthcare Provider Details

I. General information

NPI: 1912009861
Provider Name (Legal Business Name): JASON GRANT HOLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00
COLUMBIA MO
65212-5822
US

IV. Provider business mailing address

UNIVERSITY OF MISSOURI HOSPITAL 1 HOSPITAL DR DC032.00
COLUMBIA MO
65212-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2100
  • Fax: 573-884-6109
Mailing address:
  • Phone: 573-882-2100
  • Fax: 573-884-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN0102
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT2004016534
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN0102
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2020019644
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: