Provider Demographics
NPI:1275612277
Name:HOLDREN, DALE NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:NORMAN
Last Name:HOLDREN
Suffix:
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 1:2655 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3318
Mailing Address - Country:US
Mailing Address - Phone:360-377-3703
Mailing Address - Fax:360-377-9469
Practice Address - Street 1:2655 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3318
Practice Address - Country:US
Practice Address - Phone:360-377-3703
Practice Address - Fax:360-377-9469
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0025209MD00031837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1094291Medicaid
WA115000650Medicare ID - Type Unspecified
WA1094291Medicaid