Provider Demographics
NPI:1164641932
Name:HOLDEMAN, TROY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ALLEN
Last Name:HOLDEMAN
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 1:700 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9013
Mailing Address - Country:US
Mailing Address - Phone:316-283-2800
Mailing Address - Fax:
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9013
Practice Address - Country:US
Practice Address - Phone:316-283-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200527920BMedicaid
KS200527920BMedicaid