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General NPI Number Information
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NPI Number | 1134117732
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Entity Type | Individual
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Provider Name | JOHN B HOLDS MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 12990 MANCHESTER RD STE 102
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1804
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Country | US
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Telephone | 314-567-3567
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Fax | 314-567-6575
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Provider Business Mailing Address
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Address Line | 12990 MANCHESTER RD STE 102
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1804
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Country | US
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Telephone | 314-567-3567
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Fax | 314-567-6575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | R3N98
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License Number State | MO
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