Healthcare Provider Details

I. General information

NPI: 1215938394
Provider Name (Legal Business Name): JOHN R HOLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 IRONWOOD DR SUITE 2102
MINDEN NV
89423-5178
US

IV. Provider business mailing address

PO BOX 4540
CARSON CITY NV
89702-4540
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7745
  • Fax: 775-782-0073
Mailing address:
  • Phone: 775-882-0430
  • Fax: 775-852-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13250
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: