Healthcare Provider Details

I. General information

NPI: 1982607776
Provider Name (Legal Business Name): TODD READ HOLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N 4TH ST STE A
LONGVIEW TX
75601-4768
US

IV. Provider business mailing address

PO BOX 847176
DALLAS TX
75284-7176
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-3808
  • Fax: 903-757-3893
Mailing address:
  • Phone: 903-237-1800
  • Fax: 903-237-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberF9577
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberF9577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: