Healthcare Provider Details

I. General information

NPI: 1801876834
Provider Name (Legal Business Name): TIMOTHY TROY HOLBERT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 400
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

PO BOX 12546
GLENDALE AZ
85083
US

V. Phone/Fax

Practice location:
  • Phone: 602-667-7900
  • Fax: 602-667-7993
Mailing address:
  • Phone: 623-229-4674
  • Fax: 623-533-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2021
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: