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General NPI Number Information
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NPI Number | 1881791358
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Entity Type | Individual
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Provider Name | IRA HAWKINS HOLT M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 18704 HIGHWAY 11 N
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City | VANCE
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State | AL
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Zip | 35490-2434
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Country | US
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Telephone | 205-481-8510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-0777
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Country | US
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Telephone | 205-481-7670
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Fax | 205-481-7573
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 00003739
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License Number State | AL
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