Provider Demographics
NPI:1568466167
Name:HOLTZ, ANDREW F (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:F
Last Name:HOLTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:208-884-3770
Mailing Address - Fax:541-278-8360
Practice Address - Street 1:3080 E GENTRY WAY
Practice Address - Street 2:STE 200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3544
Practice Address - Country:US
Practice Address - Phone:208-884-3770
Practice Address - Fax:541-278-8360
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1302957Medicare PIN
IDH93074Medicare UPIN