Healthcare Provider Details

I. General information

NPI: 1093986804
Provider Name (Legal Business Name): PAUL KENNETH HOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15757 N 78TH ST SUITE A
SCOTTSDALE AZ
85260-1680
US

IV. Provider business mailing address

15757 N 78TH ST SUITE A
SCOTTSDALE AZ
85260-1680
US

V. Phone/Fax

Practice location:
  • Phone: 480-787-5815
  • Fax: 480-787-5814
Mailing address:
  • Phone: 480-787-5815
  • Fax: 480-787-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA95064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01065964A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number43170
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA95064
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01065964A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number43170
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: