Healthcare Provider Details

I. General information

NPI: 1902571508
Provider Name (Legal Business Name): RICHARD DAVIS HOLMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE # 354755
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

4245 ROOSEVELT WAY NE # 354755
SEATTLE WA
98105-6008
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-6868
  • Fax:
Mailing address:
  • Phone: 206-598-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD61162212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: