Basic Information
Provider Information | |||||||||
NPI: | 1952518144 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLZER | ||||||||
FirstName: | TAMARA | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BLAIR | ||||||||
OtherFirstName: | TAMARA | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1330 COSHOCTON AVE | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | OH | ||||||||
PostalCode: | 43050 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403939000 | ||||||||
FaxNumber: | 7403920167 | ||||||||
Practice Location | |||||||||
Address1: | 1330 COSHOCTON AVE | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | OH | ||||||||
PostalCode: | 43050 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403939000 | ||||||||
FaxNumber: | 7403920167 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2007 | ||||||||
LastUpdateDate: | 03/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 58-001860 | OH | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 56098 | WI | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 4198 | IA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 34013954 | OH | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.