Provider Demographics
NPI:1790760817
Name:HOLLOWAY, TAMARA JOY (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:JOY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268922
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8922
Mailing Address - Country:US
Mailing Address - Phone:405-272-6406
Mailing Address - Fax:405-272-6075
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:ROOM 4404
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-6406
Practice Address - Fax:405-272-6075
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200043990AMedicaid
OKP00151817OtherRAILROAD MEDICARE
OKOKA103159Medicare PIN