Provider Demographics
NPI:1205800422
Name:HOLTZ, ROBERT J (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
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 1:5858 W MAIN ST STE 130
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4507
Mailing Address - Country:US
Mailing Address - Phone:214-387-4073
Mailing Address - Fax:214-387-8395
Practice Address - Street 1:5858 W MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4507
Practice Address - Country:US
Practice Address - Phone:214-387-4073
Practice Address - Fax:214-387-8395
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7010OtherBC/BS
TX146012301Medicaid
TXTXB151434Medicare PIN
TXTXB151429Medicare PIN
TX8307M9Medicare PIN
TX146012301Medicaid
TXTXB151431Medicare PIN