Provider Demographics
NPI:1407928765
Name:HOLMAN, PHILLIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:HOLMAN
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 1:715 KENSINTGTON AVENUE, SUITE24B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8644
Mailing Address - Country:US
Mailing Address - Phone:406-830-3924
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINTGTON AVE.
Practice Address - Street 2:SUITE 24B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8644
Practice Address - Country:US
Practice Address - Phone:406-830-3294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11208207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTE24076Medicare UPIN