Healthcare Provider Details

I. General information

NPI: 1083667893
Provider Name (Legal Business Name): ROBERT ALLEN HOLUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N MAIN AVE STE 120
SAN ANTONIO TX
78212-4738
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 STE 300
SAN ANTONIO TX
78232-2679
US

V. Phone/Fax

Practice location:
  • Phone: 210-226-2001
  • Fax: 210-226-5211
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-499-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM1149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: