Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 19951 | OK |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 19951 | OK |
NPI | 1275537516 |
---|---|
Provider Name | Dr. Timothy W. Holder |
First Address | Tulsa, OK 74136-3903 |
Second Address | Tulsa, OK 74136-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0458450140 | (05) | OK |
C17022 | (02) | OK |