Healthcare Provider Details

I. General information

NPI: 1689638041
Provider Name (Legal Business Name): ROBERT HOLM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1939
  • Fax:
Mailing address:
  • Phone: 740-446-5201
  • Fax: 740-446-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34006443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: