Healthcare Provider Details

I. General information

NPI: 1952363848
Provider Name (Legal Business Name): JEAN EDWARDS HOLT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E SONTERRA BLVD SUITE 100
SAN ANTONIO TX
78258-4054
US

IV. Provider business mailing address

325 E SONTERRA BLVD SUITE 100
SAN ANTONIO TX
78258-4054
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-6759
  • Fax: 210-490-6507
Mailing address:
  • Phone: 210-490-6759
  • Fax: 210-490-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF2714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: