Provider Demographics
NPI:1538183884
Name:HOLT, RAYMOND ROBERT (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ROBERT
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-390-8320
Mailing Address - Fax:843-390-8329
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7832
Practice Address - Country:US
Practice Address - Phone:843-390-8320
Practice Address - Fax:843-390-8329
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32416207Q00000X
NY206751-2207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
52007JMedicare PIN
G34314Medicare UPIN