Provider Demographics
NPI:1093986804
Name:HOLDEN, PAUL KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15757 N 78TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1680
Mailing Address - Country:US
Mailing Address - Phone:480-787-5815
Mailing Address - Fax:480-787-5814
Practice Address - Street 1:15757 N 78TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1680
Practice Address - Country:US
Practice Address - Phone:480-787-5815
Practice Address - Fax:480-787-5814
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA95064207YS0123X, 207Y00000X
IN01065964A207YS0123X, 207Y00000X
AZ43170207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology