Provider Demographics
NPI:1245216878
Name:HOLMES, MAURICE A (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4787
Mailing Address - Country:US
Mailing Address - Phone:281-692-1720
Mailing Address - Fax:281-692-1783
Practice Address - Street 1:18300 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6302
Practice Address - Country:US
Practice Address - Phone:281-333-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8372207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169657701Medicaid
TX169657703Medicaid
TX169657702Medicaid
TX8G4119OtherBCBSTX PROV NO
TX8C8637Medicare PIN
TX8G4119OtherBCBSTX PROV NO
TX8L16688Medicare PIN
TXI21272Medicare UPIN
TX169657703Medicaid
TXP00192820Medicare PIN