Individual
WALTER G HOLLOMAN JR.
Active
Individual
WALTER G HOLLOMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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