Organization
DWIGHT HOLDEN MD FAPA INC.
Active
Other names
Dwight Holden, MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DWIGHT HOLDEN MD (OWNER)
(505) 988-7476
Entity
Organization
Contact information
Practice address
3 EAST GOLDEN EAGLE RD., SANTA FE, NM 87506-8223
(505) 988-7476
(505) 986-6453
Mailing address
3 EAST GOLDEN EAGLE RD., SANTA FE, NM 87506-8223
(505) 988-7476
(505) 986-6453
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
16440
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10047270A
MEDICAID PROVIDER ID
OK
01
—
1033133384
NPI INDIVIDUAL PROVIDER #
—
Enumeration date
08/19/2006
Last updated
07/12/2007
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