Individual
DR. BRIAN A HOLTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31003 N 118TH LN, PEORIA, AZ 85383-8240
(623) 242-6958
Mailing address
31003 N 118TH LN, PEORIA, AZ 85383-8240
(623) 242-6958
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36220
AZ
2085R0202X
Diagnostic Radiology Physician
3921A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103629700
—
WY
05
—
1265469399
—
UT
05
—
179931
—
AZ
01
—
305941
BCBS OF WY
WY
01
—
83022243882901A002
TRIWEST COLLEGE
WY
01
—
83022243882935A002
TRIWEST UINTA
WY
Enumeration date
06/26/2006
Last updated
07/28/2016
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