Provider Demographics
NPI:1932358611
Name:JOEL E. HOLLOWAY, M.D. INC.
Entity Type:Organization
Organization Name:JOEL E. HOLLOWAY, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-321-5022
Mailing Address - Street 1:2500 MCGEE DR
Mailing Address - Street 2:STE 148
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6722
Mailing Address - Country:US
Mailing Address - Phone:405-321-5022
Mailing Address - Fax:405-321-0785
Practice Address - Street 1:2500 MCGEE DR
Practice Address - Street 2:STE 148
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6722
Practice Address - Country:US
Practice Address - Phone:405-321-5022
Practice Address - Fax:405-321-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK443408220Medicare PIN
OKD34809Medicare UPIN