Provider Demographics
NPI:1093878381
Name:VLADIMIR HOLY, MD, PC
Entity Type:Organization
Organization Name:VLADIMIR HOLY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-422-6337
Mailing Address - Street 1:2315 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2149
Mailing Address - Country:US
Mailing Address - Phone:405-422-6337
Mailing Address - Fax:405-422-6341
Practice Address - Street 1:2315 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2149
Practice Address - Country:US
Practice Address - Phone:405-422-6337
Practice Address - Fax:405-422-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20362207Q00000X, 207V00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK150886566-002OtherBLUE CROSS BLUE SHIELD
OK150886566-002OtherBLUE CROSS BLUE SHIELD