Healthcare Provider Details

I. General information

NPI: 1689722241
Provider Name (Legal Business Name): MATTHEW C HOLDEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 53794
LAFAYETTE LA
70505-3794
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7198
  • Fax: 337-289-7199
Mailing address:
  • Phone: 337-289-7198
  • Fax: 337-289-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW C HOLDEN
Title or Position: PRESIDENT
Credential: MD
Phone: 337-289-7198