=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023358223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN D HOLMES MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2013
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 S DOBSON RD A207
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85202-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-461-0082
-----------------------------------------------------
Fax | 480-964-4237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 S DOBSON RD A207
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85202-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-461-0082
-----------------------------------------------------
Fax | 480-964-4237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN DOUGLAS HOLMES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-461-0082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 15472
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------