Basic Information
| Provider Information | |||||||||
| NPI: | 1679526453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLTZMAN | ||||||||
| FirstName: | LIAM | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1329 SW 16TH ST | ||||||||
| Address2: | SUITE 5270 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522655911 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1329 SW 16TH ST | ||||||||
| Address2: | SUITE 5270 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522655911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | H61923 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS9524 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 405105000 | 05 | MD | MEDICAID | 274605100 | 05 | FL | MEDICAID |