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General NPI Number Information
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NPI Number | 1407928765
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Entity Type | Individual
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Provider Name | PHILLIP M HOLMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 715 KENSINTGTON AVE. SUITE 24B
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City | MISSOULA
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State | MT
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Zip | 59801-8644
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Country | US
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Telephone | 406-830-3294
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Fax |
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Provider Business Mailing Address
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Address Line | 715 KENSINTGTON AVENUE, SUITE24B
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City | MISSOULA
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State | MT
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Zip | 59801-8644
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Country | US
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Telephone | 406-830-3924
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11208
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 11208
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License Number State | MT
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