Provider Demographics
NPI:1376648030
Name:HOLMES, JEFFREY TAGGART (MD, JD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TAGGART
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD, JD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 SAMARITAN DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-356-5557
Mailing Address - Fax:408-356-5514
Practice Address - Street 1:2585 SAMARITAN DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-356-5557
Practice Address - Fax:408-356-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51168Medicare UPIN