Healthcare Provider Details

I. General information

NPI: 1912049362
Provider Name (Legal Business Name): VIRAN ROGER HOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E HIGHWAY 60
MONETT MO
65708-9311
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4880
  • Fax: 417-882-7843
Mailing address:
  • Phone: 239-432-8331
  • Fax: 831-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2005014684
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-7162
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2005014684
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: