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Individual

DOUGLAS W HOLTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
817 S ELM PL, SUITE A, BROKEN ARROW, OK 74012-5369
(918) 251-2273
(918) 258-6446
Mailing address
817 S ELM PL, SUITE A, BROKEN ARROW, OK 74012-5369
(918) 251-2273
(918) 258-6446

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15244
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100172440D
OK
01
300392142
TRICARE
OK
01
300392142001
BLUECROSS BLUE SHIELD
OK
01
P00389602
RAILROAD MEDICARE
OK
Enumeration date
01/27/2006
Last updated
02/25/2008
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