=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205416559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMERON MATTHEW HOLMES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2021
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 N BISHOP AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75208-4114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-942-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5126 BYERS AVE
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-262-7107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | V6953
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------