Doctor Name: | KEVIN HOLTHAUS |
NPI Number: | 1003893215 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME43785 |
Business Practice Address: | 1361 13th Ave S Ste 150 Jacksonville Beach, FL - 322503233 |
Business Phone Number: | 9042427177 |
Business Fax Number: | 9042427133 |
Mailing Address: | Po Box 17809, JACKSONVILLE |
State: | FL |
Postal Code: | 322457809 |
Phone Number: | 9047230015 |
Fax Number: | 9043380951 |
NPI Enumeration Date: | 12/29/2005 |
NPI Last Update Date: | 11/21/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME43785 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |