Provider Demographics
NPI:1942263116
Name:HOLMAN, DAVID O JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:HOLMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1023 CREEKSIDE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-8624
Mailing Address - Country:US
Mailing Address - Phone:803-684-3738
Mailing Address - Fax:803-684-3808
Practice Address - Street 1:1023 CREEKSIDE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-8624
Practice Address - Country:US
Practice Address - Phone:803-684-3738
Practice Address - Fax:803-684-3808
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC070595Medicaid
SC5915486Medicaid
SCD17798Medicare UPIN
SCD177988397Medicare PIN
SC5915486Medicaid