Provider Demographics
NPI:1003018961
Name:JAMES H. HOLMES, JR., M.D., INC.
Entity Type:Organization
Organization Name:JAMES H. HOLMES, JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-8683
Mailing Address - Street 1:1502 ST. MARK'S PLAZA
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6409
Mailing Address - Country:US
Mailing Address - Phone:209-466-8683
Mailing Address - Fax:209-466-8309
Practice Address - Street 1:1502 ST. MARK'S PLAZA
Practice Address - Street 2:SUITE 5
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6409
Practice Address - Country:US
Practice Address - Phone:209-466-8683
Practice Address - Fax:209-466-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30996207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44629Medicare UPIN
CA00G309961Medicare PIN
CAZZZ05913ZMedicare PIN