Healthcare Provider Details

I. General information

NPI: 1720387061
Provider Name (Legal Business Name): CASEY JACOB HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CREEKSIDE PKWY STE 100
NAPLES FL
34108-2068
US

IV. Provider business mailing address

1175 CREEKSIDE PKWY STE 100
NAPLES FL
34108-2068
US

V. Phone/Fax

Practice location:
  • Phone: 239-594-9100
  • Fax: 239-594-3054
Mailing address:
  • Phone: 239-594-9100
  • Fax: 239-594-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.059766
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME134603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: