Provider Demographics
NPI:1447319991
Name:HOLDEN, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - Street 2:301 UNIVERSITY BLVD, ROUTE 0569
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0569
Mailing Address - Country:US
Mailing Address - Phone:409-772-1176
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - Street 2:301 UNIVERSITY BLVD, ROUTE 0569
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0569
Practice Address - Country:US
Practice Address - Phone:409-772-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-40165OtherEVERCARE
TX129074404Medicaid
8V8102OtherBCBS TX
P00690862OtherRR MEDICARE
C17019Medicare UPIN
04-40165OtherEVERCARE