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General NPI Number Information
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NPI Number | 1912533589
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Entity Type | Individual
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Provider Name | DAVID BENJAMIN HOLT PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 708 LEXINGTON AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4738
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Country | US
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Telephone | 479-226-3132
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Fax | 479-226-3136
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Provider Business Mailing Address
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Address Line | 9505 CHAD COLLEY BLVD APT 1707
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City | FORT SMITH
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State | AR
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Zip | 72916-5808
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Country | US
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Telephone | 501-590-2720
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PT2020-025
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License Number State | AR
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