Healthcare Provider Details

I. General information

NPI: 1255431334
Provider Name (Legal Business Name): RONALD DEAN HOLMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9224 TEDDY LN #200
LONE TREE CO
80124-6798
US

IV. Provider business mailing address

9224 TEDDY LN #200
LONE TREE CO
80124-6798
US

V. Phone/Fax

Practice location:
  • Phone: 303-869-2121
  • Fax: 303-860-1597
Mailing address:
  • Phone: 303-869-2121
  • Fax: 303-860-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number38169
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: