MEDICARE: DR. H SPENCER HOLMES M.D.

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	207N00000X	Dermatology Physician	21041	MN

General Provider Information

NPI Number	:	1497738975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. H SPENCER HOLMES M.D.

Provider Business Mailing Address
First Line	:	1295 WALNUT GROVE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1093
Country	:	US
Telephone Number	:	952-237-4147
Fax Number	:	952-993-0333

Provider Business Practice Location Address
First Line	:	1295 WALNUT GROVE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1093
Country	:	US
Telephone Number	:	952-237-4147
Fax Number	:	952-993-0333

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	03/31/2017

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