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Individual

RUSSELL HOLDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
7818 E 55TH ST, TULSA, OK 74145-7817
(918) 549-1143
Mailing address
615 S 32ND ST, MUSKOGEE, OK 74401-5012
(539) 239-5240
(539) 239-5249

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4945
OK

Other

Enumeration date
08/30/2021
Last updated
02/14/2024
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