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General NPI Number Information
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NPI Number | 1326074857
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Entity Type | Organization
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Legal Business Name | NEUROLOGY PA
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 4161 TAMIAMI TRL SUITE 201
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9208
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Country | US
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Telephone | 941-764-0800
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Fax | 941-764-6494
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Provider Business Mailing Address
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Address Line | 4161 TAMIAMI TRL SUITE 201
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9208
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Country | US
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Telephone | 941-764-0800
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Fax | 941-764-6494
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM A HOLT
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Credential | D.O.
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Telephone | 941-764-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME85919
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME99150
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101267
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS5338
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License Number State | FL
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