Healthcare Provider Details

I. General information

NPI: 1144277120
Provider Name (Legal Business Name): DROR HOLZMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

PO BOX 24584
SEATTLE WA
98124-0584
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15265
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005016
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: