Healthcare Provider Details

I. General information

NPI: 1740217819
Provider Name (Legal Business Name): JAMES A HOLB RD,LD,CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 FLAGSTAFF CV
FORT WAYNE IN
46815-4417
US

IV. Provider business mailing address

4210 FLAGSTAFF CV
FORT WAYNE IN
46815-4417
US

V. Phone/Fax

Practice location:
  • Phone: 260-489-9009
  • Fax: 260-489-5057
Mailing address:
  • Phone: 260-489-9009
  • Fax: 260-489-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: