Provider Demographics
NPI:1265615132
Name:KOLTZ, DAVID ALAN
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:KOLTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3106
Mailing Address - Country:US
Mailing Address - Phone:713-852-6682
Mailing Address - Fax:
Practice Address - Street 1:3000 RICHMOND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3102
Practice Address - Country:US
Practice Address - Phone:713-852-6682
Practice Address - Fax:713-512-6448
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012394662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology