Provider Demographics
NPI:1457385510
Name:HOLLINGSWORTH, ALAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:HOLLINGSWORTH
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 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:4300 MCAULEY BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8302
Practice Address - Country:US
Practice Address - Phone:405-936-5455
Practice Address - Fax:405-936-5217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK17029OtherOBNDD
OK100110110AMedicaid
OKP00199417OtherRAILROAD
OK10885OtherLICENSE
A45965Medicare UPIN
OK100110110AMedicaid