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NPI Code Detail

MEDICARE: SHEA RYAN HOLT M.D.

MEDICARE: SHEA RYAN HOLT M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RN0300XNephrology PhysicianN9377TX

General Provider Information

NPI Number : 1376722009
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEA RYAN HOLT M.D.
Provider Business Mailing Address
First Line : 2221 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1812
Country : US
Telephone Number : 817-336-5060
Fax Number : 817-336-1744
Provider Business Practice Location Address
First Line : 2221 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1812
Country : US
Telephone Number : 817-336-5060
Fax Number : 817-336-1744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2007
Last Update Date : 03/22/2021

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Directions to “ SHEA RYAN HOLT M.D.” Practice Location

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