Provider Demographics
NPI:1720094816
Name:HOLDEN, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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 1:2321 N WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-5613
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-681-8620
Practice Address - Street 1:2321 N WISCONSIN AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-681-8620
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
ILIL01K5OtherJOHN DEERE
IL010788OtherHEALTH ALLIANCE
IL0360491673Medicaid
IL080195132OtherRAILROAD MEDICARE
IL253462OtherHEALTHLINK
IL7215059OtherBCBS PPO