Healthcare Provider Details

I. General information

NPI: 1679680730
Provider Name (Legal Business Name): G. RICHARD HOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FLOYD CURL DR
SAN ANTONIO TX
78229-3931
US

IV. Provider business mailing address

8300 FLOYD CURL DR
SAN ANTONIO TX
78229-3931
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9950
  • Fax:
Mailing address:
  • Phone: 210-450-9950
  • Fax: 210-450-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberF2713
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberF2713
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: