Healthcare Provider Details

I. General information

NPI: 1750698635
Provider Name (Legal Business Name): JONATHAN WILLIAM HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6890
US

IV. Provider business mailing address

5933 FOREST RIVER DR
FORT WORTH TX
76112-1057
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01071449A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA122213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: