Healthcare Provider Details

I. General information

NPI: 1689132540
Provider Name (Legal Business Name): MICHAEL C. HOLMES, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 E WHITESTONE BLVD STE 2104
CEDAR PARK TX
78613-9079
US

IV. Provider business mailing address

1464 E WHITESTONE BLVD STE 2104
CEDAR PARK TX
78613-9079
US

V. Phone/Fax

Practice location:
  • Phone: 512-260-8100
  • Fax: 512-260-8103
Mailing address:
  • Phone: 512-260-8100
  • Fax: 512-260-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HOLMES
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 504-813-7701