Provider Demographics
NPI:1588688212
Name:HOLT, ROBERT EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 G ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2463
Mailing Address - Country:US
Mailing Address - Phone:785-527-2237
Mailing Address - Fax:785-527-2820
Practice Address - Street 1:2337 G ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2463
Practice Address - Country:US
Practice Address - Phone:785-527-2237
Practice Address - Fax:785-527-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001019OtherBLUECROSS BLUESHIELD KS
KS100209700AHMedicaid
KSD17343Medicare UPIN
KS100209700AHMedicaid