Healthcare Provider Details

I. General information

NPI: 1497753495
Provider Name (Legal Business Name): JAMES WILLIAM HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST SUITE 503
LOUISVILLE KY
40202-1835
US

IV. Provider business mailing address

601 S FLOYD ST SUITE 503
LOUISVILLE KY
40202-1835
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-0802
  • Fax: 502-589-0805
Mailing address:
  • Phone: 502-589-0802
  • Fax: 502-589-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number15879
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: