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NPI Code Detail

MEDICARE: COREY RYAN HOLT DO

MEDICARE:   COREY RYAN HOLT  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDO3413NV

General Provider Information

NPI Number : 1306461090
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY RYAN HOLT DO
Provider Business Mailing Address
First Line : 1649 LUCERNE ST STE A
Second Line :
City : MINDEN
State : NV
Zip : 89423-4361
Country : US
Telephone Number : 775-782-1603
Fax Number : 775-782-3417
Provider Business Practice Location Address
First Line : 1649 LUCERNE ST STE A
Second Line :
City : MINDEN
State : NV
Zip : 89423-4361
Country : US
Telephone Number : 775-782-1603
Fax Number : 775-782-3417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2020
Last Update Date : 12/10/2025

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Directions to “ COREY RYAN HOLT DO” Practice Location

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