Provider Demographics
NPI:1649344839
Name:HOLY, VLADIMIR (MD)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:HOLY
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 1:2315 PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036
Mailing Address - Country:US
Mailing Address - Phone:405-422-6337
Mailing Address - Fax:405-422-6341
Practice Address - Street 1:2315 PARKVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:405-422-6337
Practice Address - Fax:405-422-6341
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20362207Q00000X, 207V00000X, 208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100020560EMedicaid
OK100020560AMedicaid
OKG29098Medicare UPIN
G29098Medicare UPIN
OK100020560EMedicaid