Provider Demographics
NPI:1043541964
Name:HOLTZMAN, DONALD EUGENE (IDC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS NEBRASKA SSBN 739 GOLD
Mailing Address - Street 2:2100 THRESHER AVE
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96673-2133
Mailing Address - Country:US
Mailing Address - Phone:360-315-4210
Mailing Address - Fax:360-396-6362
Practice Address - Street 1:USS NEBRASKA SSBN 739 GOLD
Practice Address - Street 2:2100 THRESHER AVE
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96673-2133
Practice Address - Country:US
Practice Address - Phone:360-315-4210
Practice Address - Fax:360-396-6362
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman