MEDICARE: DR. MICHAEL CHRISTOPHER HOLMES 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	208000000X	Pediatrics Physician	N3736	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3891389970	OTHER		MYUTMB 3891389970-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588868152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CHRISTOPHER HOLMES MD

Provider Business Mailing Address
First Line	:	104 SEMINOLE CANYON DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-7193
Country	:	US
Telephone Number	:	504-813-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1464 E WHITESTONE BLVD
Second Line	:	SUITE 901
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9058
Country	:	US
Telephone Number	:	512-260-8100
Fax Number	:	512-260-8103

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	12/01/2016

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