Healthcare Provider Details

I. General information

NPI: 1992184485
Provider Name (Legal Business Name): MARK DANIEL HOLSEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2268 36TH AVE NW STE 120
NORMAN OK
73072-3287
US

IV. Provider business mailing address

2268 36TH AVE NW STE 120
NORMAN OK
73072-3287
US

V. Phone/Fax

Practice location:
  • Phone: 405-876-8118
  • Fax: 936-244-4621
Mailing address:
  • Phone: 405-876-8118
  • Fax: 936-244-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU1035
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5997
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: