Provider Demographics
NPI:1952365355
Name:HOLZEN, THOMAS WERNER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WERNER
Last Name:HOLZEN
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 1:393 WALLACE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4880
Mailing Address - Country:US
Mailing Address - Phone:615-832-2200
Mailing Address - Fax:615-832-2020
Practice Address - Street 1:393 WALLACE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4880
Practice Address - Country:US
Practice Address - Phone:615-832-2200
Practice Address - Fax:615-832-2020
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000011936207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3169852Medicaid
TN4284211OtherBLUE CROSS BLUE SHIELD
TN2009826OtherBLUECROSS
TN3169852Medicare ID - Type Unspecified
B03373Medicare UPIN