MEDICARE: ROBERT R HOLMES JR.

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	174400000X	Specialist		NE
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255837373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT R HOLMES JR.

Provider Business Mailing Address
First Line	:	4326 GRAND AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-1855
Country	:	US
Telephone Number	:	402-612-7518
Fax Number	:

Provider Business Practice Location Address
First Line	:	4326 GRAND AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-1855
Country	:	US
Telephone Number	:	402-612-7518
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	02/03/2026

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