MEDICARE: VICTOR LAMONT HOLMES PA

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	363A00000X	Physician Assistant	PA06508	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	839N18	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194711747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR LAMONT HOLMES PA

Provider Business Mailing Address
First Line	:	PO BOX 99335
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0335
Country	:	US
Telephone Number	:	817-735-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 MONTGOMERY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2553
Country	:	US
Telephone Number	:	817-735-5800
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/13/2017

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