Provider Demographics
NPI:1124236237
Name:HOLIFIELD, EDWARD WARREN (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:WARREN
Last Name:HOLIFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:WARREN
Other - Last Name:HOLIFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6491
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-6491
Mailing Address - Country:US
Mailing Address - Phone:850-574-2792
Mailing Address - Fax:850-574-2790
Practice Address - Street 1:4032 LONGLEAF CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-6424
Practice Address - Country:US
Practice Address - Phone:850-574-2792
Practice Address - Fax:850-574-2790
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38045207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease