Provider Demographics
NPI:1275590333
Name:HOLMES, PHILLIP WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WALTER
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-685-7292
Practice Address - Street 1:1411 STATE HWY 79 EAST
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531
Practice Address - Country:US
Practice Address - Phone:218-685-7300
Practice Address - Fax:218-685-7292
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN37994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG13602Medicare UPIN