Provider Demographics
NPI:1013953041
Name:BUCHHOLTZ, BEN (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:BUCHHOLTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LONG BEACH BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2696
Mailing Address - Country:US
Mailing Address - Phone:562-426-0396
Mailing Address - Fax:562-426-7551
Practice Address - Street 1:4100 LONG BEACH BLVD
Practice Address - Street 2:#200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2696
Practice Address - Country:US
Practice Address - Phone:562-426-0396
Practice Address - Fax:562-426-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44933213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG44933Medicare ID - Type Unspecified