Healthcare Provider Details

I. General information

NPI: 1508945940
Provider Name (Legal Business Name): JAMES HENRY HOLMES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 03/07/2023
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

4540 ARCHERDALE RD
LINDEN CA
95236-9750
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-8683
  • Fax: 209-466-8309
Mailing address:
  • Phone: 209-887-3188
  • Fax: 209-887-3188

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:
Title or Position:
Credential:
Phone: