MEDICARE: LAWRENCE B HOLT JR. MD FACP

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	207RH0003X	Hematology & Oncology Physician	11181	SC
2	207RH0003X	Hematology & Oncology Physician	200100151	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871587634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE B HOLT JR. MD FACP

Provider Business Mailing Address
First Line	:	8121 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4128
Country	:	US
Telephone Number	:	843-692-5000
Fax Number	:	843-692-5015

Provider Business Practice Location Address
First Line	:	8121 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4128
Country	:	US
Telephone Number	:	843-692-5000
Fax Number	:	843-692-5015

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/14/2012

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