Provider Demographics
NPI:1679504856
Name:HOLDORF, ANNE WARREN ENGEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:WARREN ENGEL
Last Name:HOLDORF
Suffix:
Gender:F
Credentials:PA-C
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 780
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-0780
Mailing Address - Country:US
Mailing Address - Phone:361-384-3341
Mailing Address - Fax:
Practice Address - Street 1:2510 E. MAIN, SUITE 102
Practice Address - Street 2:ALICE INTERNAL MEDICINE CONSULTANTS, PA
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332
Practice Address - Country:US
Practice Address - Phone:361-664-4445
Practice Address - Fax:361-664-4449
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 00157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA 00157OtherSTATE LICENSE #
TX82N626Medicare ID - Type Unspecified
TXS78291Medicare UPIN