Provider Demographics
NPI:1871876011
Name:HOLT, OLAYINKA OMOWUNMI (MD)
Entity type:Individual
Prefix:DR
First Name:OLAYINKA
Middle Name:OMOWUNMI
Last Name:HOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 JACAMAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6225
Mailing Address - Country:US
Mailing Address - Phone:956-568-9657
Mailing Address - Fax:956-568-9659
Practice Address - Street 1:1405 JACAMAN RD STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6225
Practice Address - Country:US
Practice Address - Phone:956-568-9657
Practice Address - Fax:956-568-9659
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1765207R00000X, 208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333074801Medicaid
TX8ED520OtherBC/BS
TX317366YVJ1Medicare PIN