Provider Demographics
NPI:1053409318
Name:HOLT, ELIZABETH GUN-WHA (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GUN-WHA
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 1:1302 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6318
Mailing Address - Country:US
Mailing Address - Phone:859-608-0418
Mailing Address - Fax:859-257-9287
Practice Address - Street 1:6400 FANNIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1512
Practice Address - Country:US
Practice Address - Phone:713-704-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38972207R00000X, 207RG0100X
TXT7947207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6408247200Medicaid
KY6408247200Medicaid
KY0929107Medicare PIN