Provider Demographics
NPI:1386088672
Name:HOLT, WILLIAM WALTER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1324
Mailing Address - Country:US
Mailing Address - Phone:502-895-5951
Mailing Address - Fax:
Practice Address - Street 1:10002 MUDD LN NW
Practice Address - Street 2:
Practice Address - City:DEPAUW
Practice Address - State:IN
Practice Address - Zip Code:47115-9173
Practice Address - Country:US
Practice Address - Phone:812-633-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059297A207R00000X, 207RC0000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine