Healthcare Provider Details

I. General information

NPI: 1578054375
Provider Name (Legal Business Name): BRIAN HOLAHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LILLY RD NE STE 100
OLYMPIA WA
98506-5195
US

IV. Provider business mailing address

500 LILLY RD NE STE 100
OLYMPIA WA
98506-5195
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8525
  • Fax: 360-412-6477
Mailing address:
  • Phone: 360-413-8525
  • Fax: 360-412-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOP61678783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: