Provider Demographics
NPI:1336226877
Name:RICHARD A. HOLTZ, D.O.,P.A.
Entity Type:Organization
Organization Name:RICHARD A. HOLTZ, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-585-0599
Mailing Address - Street 1:2101 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1037
Mailing Address - Country:US
Mailing Address - Phone:727-585-0599
Mailing Address - Fax:727-585-0009
Practice Address - Street 1:2101 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1037
Practice Address - Country:US
Practice Address - Phone:727-585-0599
Practice Address - Fax:727-585-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3508204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81941Medicare ID - Type Unspecified
FLE79074Medicare UPIN