Healthcare Provider Details

I. General information

NPI: 1558359505
Provider Name (Legal Business Name): RICHARD P HOLSOPPLE II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 E 71ST ST
TULSA OK
74136-3922
US

IV. Provider business mailing address

3601 SW 160TH AVE STE 250
MIRAMAR FL
33027-6314
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4673
  • Fax:
Mailing address:
  • Phone: 954-399-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3857
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3857
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: