MEDICARE: JONATHAN M HOLMES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	25632	AZ

General Provider Information

NPI Number	:	1003895897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M HOLMES M.D.

Provider Business Mailing Address
First Line	:	655 N ALVERNON WAY STE 204
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1825
Country	:	US
Telephone Number	:	520-626-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1827
Country	:	US
Telephone Number	:	520-626-0044
Fax Number	:	520-694-1464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	10/14/2023

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