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General NPI Number Information
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NPI Number | 1053463976
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Entity Type | Individual
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Provider Name | JEFFREY PAUL HOLMGREN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 705 E TIMBER DR
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City | RHINELANDER
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State | WI
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Zip | 54501-2859
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Country | US
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Telephone | 715-362-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 8665 310TH LN NE
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City | NORTH BRANCH
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State | MN
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Zip | 55056-6516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 28973
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License Number State | WI
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