Provider Demographics
NPI:1124006887
Name:HOLMES, KARL M (PAC)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 3RD ST
Mailing Address - Street 2:PO BOX 305
Mailing Address - City:KEYSTONE
Mailing Address - State:IA
Mailing Address - Zip Code:52249-9520
Mailing Address - Country:US
Mailing Address - Phone:319-442-3215
Mailing Address - Fax:319-442-3217
Practice Address - Street 1:214 3RD ST
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:IA
Practice Address - Zip Code:52249-9520
Practice Address - Country:US
Practice Address - Phone:319-442-3215
Practice Address - Fax:319-442-3217
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS77504Medicare UPIN
IA56451Medicare ID - Type Unspecified