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NPI 1477814952

NPI 1477814952 : ERIC F HOLT M.D. : BOISE, ID

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General NPI Number Information
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    NPI Number           |    1477814952
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    Entity Type          |    Individual 
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    Provider Name        |    ERIC F HOLT M.D.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    05/31/2012
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    Last Update Date     |    05/31/2012
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Provider Practice Location Address
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    Address Line         |    999 N CURTIS RD # 502
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    City                 |    BOISE
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    State                |    ID
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    Zip                  |    83706-1336
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    Country              |    US
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    Telephone            |    208-367-2866
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    Fax                  |    208-367-2867
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Provider Business Mailing Address
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    Address Line         |    999 N CURTIS RD # 502
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    City                 |    BOISE
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    State                |    ID
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    Zip                  |    83706-1336
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    Country              |    US
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    Telephone            |    208-367-2866
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    Fax                  |    208-367-2867
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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        |    2084P0800X
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    Taxonomy Name        |    Psychiatry Physician
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    License Number       |    M2718
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    License Number State |    ID
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