Provider Demographics
NPI:1235163106
Name:HOLM, NEAL T (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:T
Last Name:HOLM
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:7800 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7228
Practice Address - Country:US
Practice Address - Phone:850-416-7262
Practice Address - Fax:850-278-3334
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172806208600000X
LA200260208600000X
MS21109208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9778591OtherAETNA
MS0773664OtherCIGNA
MS6039139OtherHEALTHSPRING
LA07090Medicaid
MS03651066Medicaid
MS6039139OtherHEALTHSPRING