Provider Demographics
NPI:1003108010
Name:HOLMES, RYAN FAUVRE (MA)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:FAUVRE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 ORIOLE PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1126
Mailing Address - Country:US
Mailing Address - Phone:310-625-7291
Mailing Address - Fax:
Practice Address - Street 1:1443 ORIOLE PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1126
Practice Address - Country:US
Practice Address - Phone:310-625-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program