Healthcare Provider Details

I. General information

NPI: 1598775660
Provider Name (Legal Business Name): GERARD HOLMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR SE SUITE 700
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

201 CEDAR SE SUITE 700
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3700
  • Fax: 505-848-3703
Mailing address:
  • Phone: 505-848-3700
  • Fax: 505-848-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number94268
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: