Provider Demographics
NPI:1982964771
Name:HOLDEN, JACK DON (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:DON
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13967 CHENAL RD
Mailing Address - Street 2:
Mailing Address - City:JARREAU
Mailing Address - State:LA
Mailing Address - Zip Code:70749-3406
Mailing Address - Country:US
Mailing Address - Phone:225-627-5860
Mailing Address - Fax:225-627-4568
Practice Address - Street 1:13967 CHENAL RD
Practice Address - Street 2:
Practice Address - City:JARREAU
Practice Address - State:LA
Practice Address - Zip Code:70749-3406
Practice Address - Country:US
Practice Address - Phone:225-627-5860
Practice Address - Fax:225-627-4568
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA009222207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology