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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, December 21, 2024 3:49 AM CST
Next Update: Saturday, December 21, 2024 12:00 PM CST

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HOLTER, JEREMY P       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: SSM SHAWNEE - HARRISON
4651 NORTH HARRISON
SHAWNEE OK 74804

Address last updated on 8/13/2024
Phone #: (405) 214-1500
Fax #: (405) 214-1507
County: POTTAWATOMIE
License: 22964
Dated: 10/1/2003
Expires: 10/1/2025
License Type: Medical Doctor
Specialty: MEDICINE/PEDIATRICS
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 2002
CME Year: 2027
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF INTERNAL MEDICINE
AMERICAN BOARD OF PEDIATRICS
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna Elect Choice
Aetna HMO
Aetna Managed Choice
Aetna PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
CIGNA HMO
CommunityCare HMO, Inc
HealthChoice
Hospital Privileges: SSM Health St. Anthony Shawnee Hospital (fmly Unity Health Ctr)
Shawnee, OK
Locations: Hours: Languages:
SSM SHAWNEE - HARRISON
4651 NORTH HARRISON
SHAWNEE OK 74804

Phone #: (405) 214-1500
Fax #: (405) 214-1507
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 11:45AM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:
2801 Saratoga
Shawnee, OK 74804

Phone #: (405) 273-5801
Fax #: (7) 200-
Mon: 7:30AM - 5:00PM
Tue: 7:30AM - 5:00PM
Wed: 7:30AM - 5:00PM
Thu: 7:30AM - 5:00PM
Fri: 7:30AM - 5:00PM
Sat: 7:30AM - 5:00PM
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
MARK LEROY DAVIS PA 801
KIM ANN RYAN PA 898

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