Provider Demographics
NPI:1629396460
Name:HOLSTEAD, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HOLSTEAD
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 1:3311 PRESCOTT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3917
Mailing Address - Country:US
Mailing Address - Phone:318-442-3384
Mailing Address - Fax:318-442-3385
Practice Address - Street 1:3311 PRESCOTT RD STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3917
Practice Address - Country:US
Practice Address - Phone:318-442-3384
Practice Address - Fax:318-442-3385
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206121208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2103130Medicaid