Provider Demographics
NPI:1801876834
Name:HOLBERT, TIMOTHY TROY (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TROY
Last Name:HOLBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12546
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85083
Mailing Address - Country:US
Mailing Address - Phone:623-229-4674
Mailing Address - Fax:623-533-3470
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-667-7900
Practice Address - Fax:602-667-7993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2015-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2021363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
64513Medicare ID - Type Unspecified
P25396Medicare UPIN