MEDICARE: DR. LEONARD PETER HOLMGREN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	9846	NV
2	2085R0202X	Diagnostic Radiology Physician	G86132	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300127929	OTHER	CA	RAILROAD MEDICARE
4	300127927	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114906088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD PETER HOLMGREN MD

Provider Business Mailing Address
First Line	:	PO BOX 19879
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2533
Country	:	US
Telephone Number	:	888-480-6640
Fax Number	:	775-852-6902

Provider Business Practice Location Address
First Line	:	2170 SOUTH AVE
Second Line	:
City	:	S LAKE TAHOE
State	:	CA
Zip	:	96150-7026
Country	:	US
Telephone Number	:	530-543-5850
Fax Number	:	530-542-9550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/05/2014

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Directions to “ DR. LEONARD PETER HOLMGREN MD” Practice Location

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