Provider Demographics
NPI:1861426439
Name:HOLDER, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:174 S CORONADO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1830
Mailing Address - Country:US
Mailing Address - Phone:520-417-9920
Mailing Address - Fax:520-417-9919
Practice Address - Street 1:174 S CORONADO DR
Practice Address - Street 2:SUITE A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2860
Practice Address - Country:US
Practice Address - Phone:520-417-9920
Practice Address - Fax:520-417-9919
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ21557207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136376Medicaid
AZE50778Medicare UPIN
AZ136376Medicaid