1366776031 NPI number — DR. GRACE BUCHANAN HOLZMAN M.D.

Table of content: DR. GRACE BUCHANAN HOLZMAN M.D. (NPI 1366776031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366776031 NPI number — DR. GRACE BUCHANAN HOLZMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLZMAN
Provider First Name:
GRACE
Provider Middle Name:
BUCHANAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366776031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WALLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78702-5240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-978-9074
Provider Business Mailing Address Fax Number:
512-978-9013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7112 ED BLUESTEIN BLVD
Provider Second Line Business Practice Location Address:
STE. 155
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78723-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-978-9300
Provider Business Practice Location Address Fax Number:
512-978-9390
Provider Enumeration Date:
09/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  C8419 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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