Provider Demographics
NPI:1205899952
Name:HOLDEN, ALFRED MASON JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:MASON
Last Name:HOLDEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MASON
Other - Middle Name:
Other - Last Name:HOLDEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE A230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-7765
Practice Address - Fax:972-566-4656
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8687208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113692105Medicaid
TX80423XOtherBCBS
TX113692104Medicaid
TXP00274705OtherRR MEDICARE
TX5639070001Medicare NSC
TXP00274705OtherRR MEDICARE
TX113692105Medicaid
TX8G2554Medicare PIN