Provider Demographics
NPI:1154359453
Name:HOLDORF, RONALD (PA-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:HOLDORF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-3135
Mailing Address - Country:US
Mailing Address - Phone:361-387-6900
Mailing Address - Fax:361-387-6922
Practice Address - Street 1:814 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-3135
Practice Address - Country:US
Practice Address - Phone:361-387-6900
Practice Address - Fax:361-387-6922
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196933902Medicaid
TX311768YLPSOtherWELLMED PTAN