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NPI Code Detail

MEDICARE: MR. PETER HOLTZ CRNA

MEDICARE: MR. PETER HOLTZ CRNA
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
1367500000XCertified Registered Nurse AnesthetistR32442NM
2367500000XCertified Registered Nurse AnesthetistAP114181TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NM006869OTHERNMINDIVIDUAL BCBS NM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477552172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER HOLTZ CRNA
Provider Business Mailing Address
First Line : 3204 RAYBURN ST
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-5124
Country : US
Telephone Number : 573-686-5550
Fax Number : 573-686-2139
Provider Business Practice Location Address
First Line : 3333 N FOSTER MALDONADO BLVD
Second Line :
City : EAGLE PASS
State : TX
Zip : 78852-5893
Country : US
Telephone Number : 830-773-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 11/30/2022

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