Provider Demographics
NPI:1013015254
Name:HOLDEN, EDSEL P II (MD)
Entity Type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:P
Last Name:HOLDEN
Suffix:II
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 1:3905 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2803
Mailing Address - Country:US
Mailing Address - Phone:256-767-5864
Mailing Address - Fax:256-263-4512
Practice Address - Street 1:3905 PEACH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2803
Practice Address - Country:US
Practice Address - Phone:256-767-5864
Practice Address - Fax:256-263-4512
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19035207RS0012X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507070Medicaid
ALP00076769OtherRAILROAD MEDICARE
AL051507070Medicaid
AL051507070Medicare ID - Type Unspecified