Provider Demographics
NPI:1255443495
Name:HOLZ, WALTER LUDWIG JR (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:LUDWIG
Last Name:HOLZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22615 CARMEL CENTER PLACE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-0000
Mailing Address - Country:US
Mailing Address - Phone:831-624-1864
Mailing Address - Fax:831-624-4327
Practice Address - Street 1:22615 CARMEL CENTER PLACE
Practice Address - Street 2:SUITE 103
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-0000
Practice Address - Country:US
Practice Address - Phone:831-624-1864
Practice Address - Fax:831-624-4327
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C319830Medicaid
CA000C19830Medicare PIN
CA00C319830Medicaid