Provider Demographics
NPI:1558332676
Name:HOLTE, DOUGLAS W (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:HOLTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S ELM PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5369
Mailing Address - Country:US
Mailing Address - Phone:918-251-2273
Mailing Address - Fax:918-258-6446
Practice Address - Street 1:817 S ELM PL
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-251-2273
Practice Address - Fax:918-258-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300392142001OtherBLUECROSS BLUE SHIELD
OK100172440DMedicaid
OK300392142OtherTRICARE
OKP00389602OtherRAILROAD MEDICARE
OKP00389602OtherRAILROAD MEDICARE
OK237710201Medicare PIN