Provider Demographics
NPI:1659878452
Name:HOLDEN, ZACHARY RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:RYAN
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 1:116 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3305
Mailing Address - Country:US
Mailing Address - Phone:727-895-5210
Mailing Address - Fax:727-821-4297
Practice Address - Street 1:116 1ST ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3305
Practice Address - Country:US
Practice Address - Phone:727-895-5210
Practice Address - Fax:727-821-4297
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME152463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112716300Medicaid
FLOP739OtherMEDICARE