Healthcare Provider Details

I. General information

NPI: 1013015254
Provider Name (Legal Business Name): EDSEL P HOLDEN II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 PEACH ST
FLORENCE AL
35630-2803
US

IV. Provider business mailing address

3905 PEACH ST
FLORENCE AL
35630-2803
US

V. Phone/Fax

Practice location:
  • Phone: 256-767-5864
  • Fax: 256-263-4512
Mailing address:
  • Phone: 256-767-5864
  • Fax: 256-263-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number19035
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number19035
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number19035
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: