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General NPI Number Information
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NPI Number | 1033133384
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Entity Type | Individual
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Provider Name | LARRY DWIGHT HOLDEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 3 E GOLDEN EAGLE RD
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City | SANTA FE
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State | NM
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Zip | 87506-8223
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Country | US
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Telephone | 505-988-7476
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Fax | 505-986-6453
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Provider Business Mailing Address
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Address Line | 3 E GOLDEN EAGLE RD
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City | SANTA FE
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State | NM
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Zip | 87506-8223
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Country | US
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Telephone | 505-988-7476
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Fax | 505-986-6453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD2004-0805
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License Number State | NM
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