Provider Demographics
NPI:1912049362
Name:HOLDEN, VIRAN ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRAN
Middle Name:ROGER
Last Name:HOLDEN
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:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:831-321-1296
Practice Address - Street 1:802 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9311
Practice Address - Country:US
Practice Address - Phone:417-882-4880
Practice Address - Fax:417-882-7843
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014684207RX0202X, 207RH0003X
ARE-7162207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207380809Medicaid
AR158396001Medicaid
AR83340OtherBLUE CROSS
MO2019944OtherMO BLUE SHIELD
AR83340OtherARK BLUE SHIELD
AR83340OtherBLUE CROSS
MO2019944OtherMO BLUE SHIELD
MO132300017Medicare PIN