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NPI Code Detail

MEDICARE: JOHN HAYDEN HOLTZCLAW AU.D.

MEDICARE: JOHN HAYDEN HOLTZCLAW AU.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist80958TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180958OTHERTXTEXAS AUDIOLOGIST LICENSE

General Provider Information

NPI Number : 1679069819
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN HAYDEN HOLTZCLAW AU.D.
Provider Business Mailing Address
First Line : 2449 HOSPITAL DR STE 280
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-1900
Country : US
Telephone Number : 318-212-7288
Fax Number : 318-212-7295
Provider Business Practice Location Address
First Line : 2449 HOSPITAL DR STE 280
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-1900
Country : US
Telephone Number : 318-212-7288
Fax Number : 318-212-7295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2018
Last Update Date : 06/10/2026

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Directions to “ JOHN HAYDEN HOLTZCLAW AU.D.” Practice Location

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