Provider Demographics
NPI:1306034228
Name:BUCHHOLZ, THOMAS (CO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4158
Mailing Address - Country:US
Mailing Address - Phone:256-534-8637
Mailing Address - Fax:256-704-0024
Practice Address - Street 1:2745 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4158
Practice Address - Country:US
Practice Address - Phone:256-534-8637
Practice Address - Fax:256-704-0024
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL335E00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist