Provider Demographics
NPI:1457664799
Name:HOLZER, ANNA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RUTH
Last Name:HOLZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:RUTH
Other - Last Name:EASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3770 8TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1048
Mailing Address - Country:US
Mailing Address - Phone:515-270-1000
Mailing Address - Fax:515-967-5581
Practice Address - Street 1:3770 8TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1048
Practice Address - Country:US
Practice Address - Phone:515-270-1000
Practice Address - Fax:515-967-5581
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-40441207Q00000X, 207Q00000X
IAR-9003390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI20940055Medicare PIN