MEDICARE: MR. RICHARD L HOLMES JR. PA-C

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	207P00000X	Emergency Medicine Physician	7129	AZ
2	363A00000X	Physician Assistant	7129	AZ

General Provider Information

NPI Number	:	1467478396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD L HOLMES JR. PA-C

Provider Business Mailing Address
First Line	:	11010 N DESERT VIEW LN
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-1787
Country	:	US
Telephone Number	:	928-600-7630
Fax Number	:	928-600-7630

Provider Business Practice Location Address
First Line	:	1810 MESQUITE AVE STE B
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5886
Country	:	US
Telephone Number	:	928-453-4600
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/14/2024

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