Provider Demographics
NPI:1578641684
Name:HOLLOWAY, JOEL E (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCGEE DR STE 148
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6705
Mailing Address - Country:US
Mailing Address - Phone:405-321-5022
Mailing Address - Fax:405-321-0785
Practice Address - Street 1:2500 MCGEE DR STE 148
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6705
Practice Address - Country:US
Practice Address - Phone:405-321-5022
Practice Address - Fax:405-321-0785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9413207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34809Medicare UPIN
OK$$$$$$$$$Medicare PIN