Provider Demographics
NPI:1518239565
Name:HOLSCHER, JOHN H (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:HOLSCHER
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 1:3392 DALEY CENTER DR
Mailing Address - Street 2:APT 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4603
Mailing Address - Country:US
Mailing Address - Phone:301-802-6301
Mailing Address - Fax:
Practice Address - Street 1:USS SENTRY
Practice Address - Street 2:MCM 3
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96660-1923
Practice Address - Country:US
Practice Address - Phone:301-802-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman