Provider Demographics
NPI:1811030174
Name:HOLTON, DON B (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:B
Last Name:HOLTON
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:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71166-2267
Mailing Address - Country:US
Mailing Address - Phone:318-221-2535
Mailing Address - Fax:318-227-8636
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4971
Practice Address - Country:US
Practice Address - Phone:318-221-2535
Practice Address - Fax:318-227-8636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0099712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1181200Medicaid
LAB64241Medicare UPIN
LA52909Medicare ID - Type Unspecified