Healthcare Provider Details

I. General information

NPI: 1346227667
Provider Name (Legal Business Name): CHRISTOPHER FREDERICK HOLST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W ASH ST
DEMING NM
88030-4000
US

IV. Provider business mailing address

PO BOX 848147
DALLAS TX
75284-8147
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-5800
  • Fax:
Mailing address:
  • Phone: 800-819-2547
  • Fax: 423-899-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036119577
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2005-0539
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: