Healthcare Provider Details

I. General information

NPI: 1023018587
Provider Name (Legal Business Name): LORI RAE HOLTZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 HORIZON LAKE DR STE 114
MEMPHIS TN
38133-8113
US

IV. Provider business mailing address

PO BOX 381442
GERMANTOWN TN
38183-1442
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-2639
  • Fax: 901-249-4563
Mailing address:
  • Phone: 901-350-2639
  • Fax: 901-249-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number31899
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTNMD31899
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31899
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: