MEDICARE: MR. RONALD HOLDORF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA00158	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311768YLPS	OTHER	TX	WELLMED PTAN

General Provider Information

NPI Number	:	1154359453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD HOLDORF PA-C

Provider Business Mailing Address
First Line	:	814 E MAIN AVE
Second Line	:
City	:	ROBSTOWN
State	:	TX
Zip	:	78380-3135
Country	:	US
Telephone Number	:	361-387-6900
Fax Number	:	361-387-6922

Provider Business Practice Location Address
First Line	:	814 E MAIN AVE
Second Line	:
City	:	ROBSTOWN
State	:	TX
Zip	:	78380-3135
Country	:	US
Telephone Number	:	361-387-6900
Fax Number	:	361-387-6922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/14/2016

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