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General NPI Number Information
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NPI Number | 1528460607
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Entity Type | Individual
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Provider Name | JOHN MILLER HOLMAN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2014
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Last Update Date | 09/21/2014
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Provider Practice Location Address
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Address Line | 4765 S ICHABOD ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-6461
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Country | US
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Telephone | 801-231-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W WRIGHTWOOD AVE APT 18
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City | CHICAGO
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State | IL
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Zip | 60614-1290
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Country | US
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Telephone | 773-388-2297
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 163812-1205
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License Number State | UT
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