Provider Demographics
NPI:1982607776
Name:HOLMAN, TODD READ (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:READ
Last Name:HOLMAN
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:PO BOX 847176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:1009 N 4TH ST
Practice Address - Street 2:STE A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4768
Practice Address - Country:US
Practice Address - Phone:903-757-3808
Practice Address - Fax:903-757-3893
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9577207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099799104Medicaid
TXC17046OtherUPIN
TX099799104Medicaid