Individual
KEVIN HOLTHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1361 13TH AVE S, STE 150, JACKSONVILLE BEACH, FL 32250-3233
(904) 242-7177
(904) 242-7133
Mailing address
PO BOX 17809, JACKSONVILLE, FL 32245-7809
(904) 723-0015
(904) 338-0951
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME43785
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110241847
RAILROAD MEDICARE
FL
01
—
15832
BCBS
FL
Enumeration date
12/29/2005
Last updated
11/21/2007
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