Provider Demographics
NPI:1902824253
Name:HOLDERMANN, JAMES SHAWN (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SHAWN
Last Name:HOLDERMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8144
Mailing Address - Country:US
Mailing Address - Phone:541-779-5227
Mailing Address - Fax:541-779-1938
Practice Address - Street 1:490 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8144
Practice Address - Country:US
Practice Address - Phone:541-779-5227
Practice Address - Fax:541-779-1938
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR299111Medicaid
ORR117317Medicare PIN
ORU81245Medicare UPIN
OR5053260001Medicare NSC