Provider Demographics
NPI:1952362444
Name:HOLSHOUSER, ALAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:HOLSHOUSER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1551 WALL ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3539
Mailing Address - Country:US
Mailing Address - Phone:636-669-2268
Mailing Address - Fax:696-669-2401
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8781
Practice Address - Country:US
Practice Address - Phone:636-498-5830
Practice Address - Fax:636-498-5846
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2011-02-11
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Provider Licenses
StateLicense IDTaxonomies
MOR1K53208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202777215Medicaid
MO202777215Medicaid
MOE56572Medicare UPIN