Provider Demographics
NPI:1457464976
Name:BRUCE J HOLTZMAN D P M P C
Entity Type:Organization
Organization Name:BRUCE J HOLTZMAN D P M P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-499-2700
Mailing Address - Street 1:6630 CONCH CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3651
Mailing Address - Country:US
Mailing Address - Phone:561-336-4369
Mailing Address - Fax:561-336-4370
Practice Address - Street 1:7060 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4650
Practice Address - Country:US
Practice Address - Phone:561-336-4369
Practice Address - Fax:561-336-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057614000Medicaid
FL4676910001Medicare NSC
FL057614000Medicaid