Individual
WALTER G HOLLOMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3015 N NEW BALLAS RD, ST LOUIS, MO 63131
(314) 996-5180
(314) 821-2180
Mailing address
55 WESTPORT PLZ, SUITE 300, SAINT LOUIS, MO 63146-3109
(314) 548-4772
(314) 548-4748
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036061640
IL
2085R0202X
Diagnostic Radiology Physician
Primary
R6596
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002013128
CARE
—
01
—
0090000352
IL BLUE
—
01
—
017012444
MO CARE
—
01
—
04802710571
IL CAID
—
01
—
135370
H LINK
—
01
—
1390
MO BLUE
—
01
—
1600226
PH PLAN
—
01
—
201047818
MO CAID
—
01
—
27600
BLUE CHOICE
—
01
—
2781
GHP
—
01
—
300066998
RR CARE
—
01
—
398023
HLT PART
—
01
—
431725842MID
MERCY
—
01
—
6167
MCARE USA
—
01
—
A12402
GATE WAY
—
Enumeration date
10/23/2006
Last updated
03/18/2009
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