MEDICARE: FRED H OLIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	E1094	TX

General Provider Information

NPI Number	:	1992709398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED H OLIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 681572
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78268-1572
Country	:	US
Telephone Number	:	210-670-9030
Fax Number	:	210-675-4072

Provider Business Practice Location Address
First Line	:	9512 MAJESTIC OAK CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3449
Country	:	US
Telephone Number	:	210-698-0607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/31/2007

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