MEDICARE: RYAN ALVIN HOLT MD

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	52380-020	WI
2	207L00000X	Anesthesiology Physician	239932	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669430898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ALVIN HOLT MD

Provider Business Mailing Address
First Line	:	325 E H ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4792
Country	:	US
Telephone Number	:	906-774-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E H ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4792
Country	:	US
Telephone Number	:	906-774-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/12/2018

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Directions to “ RYAN ALVIN HOLT MD” Practice Location

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