Healthcare Provider Details

I. General information

NPI: 1992870836
Provider Name (Legal Business Name): THOMAS STEPHENSON HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

PO BOX 816
LEWISTON ID
83501-0816
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-2511
  • Fax: 208-799-5554
Mailing address:
  • Phone: 208-743-2511
  • Fax: 208-799-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM-9514
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: