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General NPI Number Information
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NPI Number | 1720387061
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Entity Type | Individual
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Provider Name | CASEY JACOB HOLMES M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 1175 CREEKSIDE PKWY STE 100
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City | NAPLES
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State | FL
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Zip | 34108-2068
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Country | US
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Telephone | 239-594-9100
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Fax | 239-594-3054
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Provider Business Mailing Address
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Address Line | 1175 CREEKSIDE PKWY STE 100
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City | NAPLES
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State | FL
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Zip | 34108-2068
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Country | US
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Telephone | 239-594-9100
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Fax | 239-594-3054
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125.059766
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME134603
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License Number State | FL
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