MEDICARE: DR. SAMUEL LAWRENCE 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD60657280	WA
2	208100000X	Physical Medicine & Rehabilitation Physician	MD60657280	WA

General Provider Information

NPI Number	:	1073815163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LAWRENCE HOLMES M.D.

Provider Business Mailing Address
First Line	:	11511 CANTERWOOD BLVD STE 105
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-985-2949
Fax Number	:	253-985-2948

Provider Business Practice Location Address
First Line	:	11511 CANTERWOOD BLVD STE 105
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-985-2949
Fax Number	:	253-985-2948

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	04/22/2026

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