Healthcare Provider Details

I. General information

NPI: 1003018961
Provider Name (Legal Business Name): JAMES H. HOLMES, JR., M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 ST. MARK'S PLAZA SUITE 5
STOCKTON CA
95207-6409
US

IV. Provider business mailing address

1502 ST. MARK'S PLAZA SUITE 5
STOCKTON CA
95207-6409
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-8683
  • Fax: 209-466-8309
Mailing address:
  • Phone: 209-466-8683
  • Fax: 209-466-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG30996
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES HENRY HOLMES JR.
Title or Position: CORPORATION PRESIDENT
Credential: M.D.
Phone: 209-466-8683