Provider Demographics
NPI:1427020825
Name:HOLDEN, JOE B (MD)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:B
Last Name:HOLDEN
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:P.O. BOX 2098
Mailing Address - Street 2:421 NORTH AVENUE F
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526
Mailing Address - Country:US
Mailing Address - Phone:337-788-0832
Mailing Address - Fax:337-783-6210
Practice Address - Street 1:421 NORTH AVENUE F
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526
Practice Address - Country:US
Practice Address - Phone:337-788-0832
Practice Address - Fax:337-783-6210
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007957208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52065OtherMEDICARE ID
LA1027359Medicaid
B89500Medicare UPIN
LA1027359Medicaid