Healthcare Provider Details

I. General information

NPI: 1043541964
Provider Name (Legal Business Name): DONALD EUGENE HOLTZMAN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS NEBRASKA SSBN 739 GOLD 2100 THRESHER AVE
FPO AP
96673-2133
US

IV. Provider business mailing address

USS NEBRASKA SSBN 739 GOLD 2100 THRESHER AVE
FPO AP
96673-2133
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4210
  • Fax: 360-396-6362
Mailing address:
  • Phone: 360-315-4210
  • Fax: 360-396-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: