MEDICARE: DOUGLAS W HOLTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15244	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00389602	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300392142001	OTHER	OK	BLUECROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	300392142	OTHER	OK	TRICARE

General Provider Information

NPI Number	:	1558332676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS W HOLTE MD

Provider Business Mailing Address
First Line	:	817 S ELM PL
Second Line	:	SUITE A
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5369
Country	:	US
Telephone Number	:	918-251-2273
Fax Number	:	918-258-6446

Provider Business Practice Location Address
First Line	:	817 S ELM PL
Second Line	:	SUITE A
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5369
Country	:	US
Telephone Number	:	918-251-2273
Fax Number	:	918-258-6446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/25/2008

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Directions to “ DOUGLAS W HOLTE MD” Practice Location

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